Provider Demographics
NPI:1386286391
Name:GURLEY, DEBORAH J (REG LPC INTERN)
Entity type:Individual
Prefix:
First Name:DEBORAH
Middle Name:J
Last Name:GURLEY
Suffix:
Gender:F
Credentials:REG LPC INTERN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1545 HUNT RD
Mailing Address - Street 2:
Mailing Address - City:JEROME
Mailing Address - State:ID
Mailing Address - Zip Code:83338-7013
Mailing Address - Country:US
Mailing Address - Phone:208-409-6664
Mailing Address - Fax:
Practice Address - Street 1:1373 FILLMORE ST
Practice Address - Street 2:
Practice Address - City:TWIN FALLS
Practice Address - State:ID
Practice Address - Zip Code:83301-3392
Practice Address - Country:US
Practice Address - Phone:208-373-9999
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-10
Last Update Date:2019-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDCOUI-7482101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor