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General NPI Number Information
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NPI Number | 1114671849
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Entity Type | Organization
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Legal Business Name | GLIDEPATH BEHAVIORAL HEALTH, A PROFESSIONAL NURSING CORPORATION
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Dates
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Enumeration Date | 02/10/2022
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Last Update Date | 02/11/2022
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Provider Practice Location Address
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Address Line | 3122 SUGARBERRY COURT
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City | WALNUT CREEK
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State | CA
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Zip | 94598-9459
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Country | US
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Telephone | 562-667-6523
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Fax | 925-291-5500
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Provider Business Mailing Address
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Address Line | 3122 SUGARBERRY CT
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City | WALNUT CREEK
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State | CA
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Zip | 94598-1727
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Country | US
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Telephone | 562-667-6523
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Fax |
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Authorized Official
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Title or Position | PRESIDENT AND PRINCIPAL CLINICIAN
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Name | MR. JOSEPH JOHN HARRISON
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Credential | NP-C
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Telephone | 562-667-6523
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 164X00000X
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Taxonomy Name | Licensed Vocational Nurse
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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