Healthcare Provider Details

I. General information

NPI: 1821917329
Provider Name (Legal Business Name): JULIE CONQUEST
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/10/2026
Last Update Date: 07/10/2026
Certification Date: 07/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 SHATTUCK AVE STE 200
BERKELEY CA
94709-1601
US

IV. Provider business mailing address

1600 SHATTUCK AVE STE 200
BERKELEY CA
94709-1601
US

V. Phone/Fax

Practice location:
  • Phone: 415-562-0858
  • Fax:
Mailing address:
  • Phone: 415-562-0858
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number19159
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: