Healthcare Provider Details

I. General information

NPI: 1285940320
Provider Name (Legal Business Name): JULIE ANN KIRKES LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JULIE ANN MARKHAM/GRENKO/TRACY LCSW

II. Dates (important events)

Enumeration Date: 08/26/2010
Last Update Date: 09/10/2024
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

103 BODIN CIRCLE, BLD 778 VA-MENTAL HEALTH
TRAVIS AFB CA
94535
US

IV. Provider business mailing address

103 BODIN CIRCLE, BLD 778 VA-MENTAL HEALTH
TRAVIS AFB CA
94535
US

V. Phone/Fax

Practice location:
  • Phone: 707-437-1853
  • Fax: 916-561-7471
Mailing address:
  • Phone: 707-437-1853
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW86960
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: