MEDICARE: MS. JULENE DILLEHAY LCPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	LCPC232	ID

General Provider Information

NPI Number	:	1144377854
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. JULENE DILLEHAY LCPC

Provider Business Mailing Address
First Line	:	5414 W FRANKLIN RD
Second Line	:
City	:	MERIDIAN
State	:	ID
Zip	:	83642-5373
Country	:	US
Telephone Number	:	208-459-5066
Fax Number	:	208-888-7477

Provider Business Practice Location Address
First Line	:	2112 CLEVELAND BLVD
Second Line	:
City	:	CALDWELL
State	:	ID
Zip	:	83605-4432
Country	:	US
Telephone Number	:	208-459-5066
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/04/2007
Last Update Date	:	07/08/2007

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