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General NPI Number Information
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NPI Number | 1457739328
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Entity Type | Organization
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Legal Business Name | JULIE KIRKES
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Dates
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Enumeration Date | 05/12/2015
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Last Update Date | 01/18/2019
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Provider Practice Location Address
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Address Line | 5342 DUDLEY BLVD. MCCL/116
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City | MCCLELLAN
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State | CA
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Zip | 95652
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Country | US
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Telephone | 916-561-7627
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 2344
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City | NORTH HIGHLANDS
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State | CA
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Zip | 95660-8344
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Country | US
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Telephone | 575-642-0984
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MS. JULIE TRACY
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Credential | LCSW
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Telephone | 575-642-0984
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | C-07799
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License Number State | NM
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