1285940320 NPI number — MS. JULIE ANN KIRKES LCSW

Table of content: MS. JULIE ANN KIRKES LCSW (NPI 1285940320)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1285940320 NPI number — MS. JULIE ANN KIRKES LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KIRKES
Provider First Name:
JULIE
Provider Middle Name:
ANN
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
LCSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MARKHAM/GRENKO/TRACY
Provider Other First Name:
JULIE
Provider Other Middle Name:
ANN
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
LCSW
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1285940320
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/10/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
103 BODIN CIRCLE, BLD 778
Provider Second Line Business Mailing Address:
VA-MENTAL HEALTH
Provider Business Mailing Address City Name:
TRAVIS AFB
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94535
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
707-437-1853
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
103 BODIN CIRCLE, BLD 778
Provider Second Line Business Practice Location Address:
VA-MENTAL HEALTH
Provider Business Practice Location Address City Name:
TRAVIS AFB
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94535
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
707-437-1853
Provider Business Practice Location Address Fax Number:
916-561-7471
Provider Enumeration Date:
08/26/2010

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:  LCSW86960 , 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: 83225102 , issued by the state of ( NM ) . This identifiers is of the category "MEDICAID".




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