Basic Information
| Provider Information | |||||||||
| NPI: | 1780708727 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BOOHER | ||||||||
| FirstName: | JULIA | ||||||||
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| Credential: | LCSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 720 N MARR RD | ||||||||
| Address2: | |||||||||
| City: | COLUMBUS | ||||||||
| State: | IN | ||||||||
| PostalCode: | 472016660 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8123143400 | ||||||||
| FaxNumber: | 8123788367 | ||||||||
| Practice Location | |||||||||
| Address1: | 3008 BEVCHER DR | ||||||||
| Address2: | |||||||||
| City: | MADISON | ||||||||
| State: | IN | ||||||||
| PostalCode: | 472503863 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8122651918 | ||||||||
| FaxNumber: | 8122651828 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/16/2007 | ||||||||
| LastUpdateDate: | 12/23/2009 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X | 33003906A | IN | N | Behavioral Health & Social Service Providers | Social Worker | 1041C0700X | 34005878A | IN | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.