Provider Demographics
NPI:1699089458
Name:WALKER JONES, JULIE DAWN (LCPC)
Entity type:Individual
Prefix:MS
First Name:JULIE
Middle Name:DAWN
Last Name:WALKER JONES
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1090 W PARK PL
Mailing Address - Street 2:
Mailing Address - City:COEUR D ALENE
Mailing Address - State:ID
Mailing Address - Zip Code:83814-2785
Mailing Address - Country:US
Mailing Address - Phone:208-292-0303
Mailing Address - Fax:
Practice Address - Street 1:2005 N IRONWOOD PKWY STE 120
Practice Address - Street 2:
Practice Address - City:COEUR D ALENE
Practice Address - State:ID
Practice Address - Zip Code:83814-2647
Practice Address - Country:US
Practice Address - Phone:208-818-1099
Practice Address - Fax:208-924-4444
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-03
Last Update Date:2020-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLCPC-5078101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID1699089458Medicaid