Healthcare Provider Details

I. General information

NPI: 1780708727
Provider Name (Legal Business Name): JULIA BOOHER LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/16/2007
Last Update Date: 12/23/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3008 BEVCHER DR
MADISON IN
47250-3863
US

IV. Provider business mailing address

720 N MARR RD
COLUMBUS IN
47201-6660
US

V. Phone/Fax

Practice location:
  • Phone: 812-265-1918
  • Fax: 812-265-1828
Mailing address:
  • Phone: 812-314-3400
  • Fax: 812-378-8367

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number33003906A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number34005878A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: