Healthcare Provider Details

I. General information

NPI: 1154968766
Provider Name (Legal Business Name): JULI JEANNINE ANDERSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/02/2019
Last Update Date: 04/20/2026
Certification Date: 04/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

727 S GRAND AVE
PULLMAN WA
99163-2136
US

IV. Provider business mailing address

727 S GRAND AVE
PULLMAN WA
99163-2136
US

V. Phone/Fax

Practice location:
  • Phone: 208-882-2566
  • Fax: 888-972-5312
Mailing address:
  • Phone: 208-882-2566
  • Fax: 888-972-5312

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMHC.LH.61063811
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: