1225169725 NPI number — MRS. JULIA LYNN GRANT L.C.S.W.

Table of content: MRS. JULIA LYNN GRANT L.C.S.W. (NPI 1225169725)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1225169725 NPI number — MRS. JULIA LYNN GRANT L.C.S.W.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GRANT
Provider First Name:
JULIA
Provider Middle Name:
LYNN
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
L.C.S.W.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1225169725
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/29/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8177 MORGAN HILL WAY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SACRAMENTO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95828-6365
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
916-681-0965
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3050 FITE CIR
Provider Second Line Business Practice Location Address:
STE 204
Provider Business Practice Location Address City Name:
SACRAMENTO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95827-1807
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
916-600-7887
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/08/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  19517 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 19517 . This is a "L.C.S.W. LICENSE NUMBER" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 11702176 . This is a "CAQH PROVIDER #" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 9942 . This is a "PLACER COUNTY PROVIDER #" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 383319 . This is a "MHN 'PIN' NUMBER" identifier , issued by the state of ( AR ) . This identifiers is of the category "OTHER".




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