Individual
JULIE WISE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MS, LCPC, NCC
Contact information
Practice address
164 S 5TH ST, MONTPELIER, ID 83254-1557
(208) 847-4464
(208) 847-0980
Mailing address
PO BOX 336, GEORGETOWN, ID 83239-0336
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
LCPC3325
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
8C493
BLUE CROSS LCPC
ID
Enumeration date
12/29/2006
Last updated
07/09/2007
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