Healthcare Provider Details

I. General information

NPI: 1376971143
Provider Name (Legal Business Name): JULI ANN CLARK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/14/2013
Last Update Date: 10/01/2026
Certification Date: 10/01/2026
Deactivation Date: 09/16/2026
Reactivation Date: 09/24/2026

III. Provider practice location address

140 LITTON DR
GRASS VALLEY CA
95945-5077
US

IV. Provider business mailing address

9343 TECH CENTER DR # 2ND
SACRAMENTO CA
95826-2563
US

V. Phone/Fax

Practice location:
  • Phone: 530-557-0330
  • Fax:
Mailing address:
  • Phone: 916-388-6400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number164986
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code373H00000X
TaxonomyDay Training/Habilitation Specialist
License Number
License Number StateNULL
# 5
Primary TaxonomyN
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number StateNULL
# 6
Primary TaxonomyN
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: