Healthcare Provider Details

I. General information

NPI: 1053494443
Provider Name (Legal Business Name): JULIE ANN BRUSAW MA LCPC LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/23/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1035 BALDY MOUNTAIN RD
SANDPOINT ID
83864-9250
US

IV. Provider business mailing address

10561 SAGLE RD
SAGLE ID
83860-8836
US

V. Phone/Fax

Practice location:
  • Phone: 208-255-9277
  • Fax: 208-255-1254
Mailing address:
  • Phone: 208-255-9277
  • Fax: 208-255-1254

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLCPC-2639
License Number StateID
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberLMFT-2640
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: