Healthcare Provider Details

I. General information

NPI: 1114671849
Provider Name (Legal Business Name): GLIDEPATH BEHAVIORAL HEALTH, A PROFESSIONAL NURSING CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/10/2022
Last Update Date: 02/11/2022
Certification Date: 02/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3122 SUGARBERRY COURT
WALNUT CREEK CA
94598-9459
US

IV. Provider business mailing address

3122 SUGARBERRY CT
WALNUT CREEK CA
94598-1727
US

V. Phone/Fax

Practice location:
  • Phone: 562-667-6523
  • Fax: 925-291-5500
Mailing address:
  • Phone: 562-667-6523
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code164X00000X
TaxonomyLicensed Vocational Nurse
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MR. JOSEPH JOHN HARRISON
Title or Position: PRESIDENT AND PRINCIPAL CLINICIAN
Credential: NP-C
Phone: 562-667-6523