Provider Demographics
NPI:1366769515
Name:JOHNSON-YAVRUIAN, JANELLE (LCSW)
Entity type:Individual
Prefix:
First Name:JANELLE
Middle Name:
Last Name:JOHNSON-YAVRUIAN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:JANELLE
Other - Middle Name:
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:4055 N LA MESITA WAY
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83702-1554
Mailing Address - Country:US
Mailing Address - Phone:208-600-2285
Mailing Address - Fax:
Practice Address - Street 1:1010 W HAYS ST
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83702-5435
Practice Address - Country:US
Practice Address - Phone:208-600-2285
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-28
Last Update Date:2024-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLCSW-330751041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical