MEDICARE: MRS. JULIE ANN GRAMER M.ED, LMFT

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	106H00000X	Marriage & Family Therapist	LMFT 2629	ID
2	101YP2500X	Professional Counselor	LPC-P 0080	ID

General Provider Information

NPI Number	:	1417206483
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JULIE ANN GRAMER M.ED, LMFT

Provider Business Mailing Address
First Line	:	2036 S CREEKSIDE LN
Second Line	:
City	:	BOISE
State	:	ID
Zip	:	83706-4039
Country	:	US
Telephone Number	:	503-502-9936
Fax Number	:

Provider Business Practice Location Address
First Line	:	1423 W FRANKLIN ST
Second Line	:
City	:	BOISE
State	:	ID
Zip	:	83702-5024
Country	:	US
Telephone Number	:	727-327-7656
Fax Number	:

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

Provider Enumeration Date	:	09/05/2012
Last Update Date	:	05/21/2013

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