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General NPI Number Information
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NPI Number | 1881941631
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Entity Type | Individual
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Provider Name | JULIE SEVERSON LCPC
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Gender | Female
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Dates
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Enumeration Date | 08/11/2012
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Last Update Date | 05/05/2022
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Provider Practice Location Address
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Address Line | 3350 W AMERICANA TER STE 210A
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City | BOISE
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State | ID
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Zip | 83706-2521
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Country | US
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Telephone | 208-623-8530
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Fax | 888-604-8113
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Provider Business Mailing Address
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Address Line | 428 W FALL DR
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City | BOISE
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State | ID
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Zip | 83706-4822
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Country | US
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Telephone | 208-965-7600
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Fax | 888-604-8113
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number | 5010
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License Number State | ID
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | LCPC-6151
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License Number State | ID
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