Healthcare Provider Details

I. General information

NPI: 1154570653
Provider Name (Legal Business Name): JULIE KATHRYN BIRT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/09/2008
Last Update Date: 12/08/2025
Certification Date: 12/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7240 E SOUTHGATE DR
SACRAMENTO CA
95823-2627
US

IV. Provider business mailing address

2086 HOLT DR
LODI CA
95242-4812
US

V. Phone/Fax

Practice location:
  • Phone: 916-391-4293
  • Fax: 916-391-4293
Mailing address:
  • Phone: 760-500-8654
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberR1579700924
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: