Provider Demographics
NPI:1285940320
Name:KIRKES, JULIE ANN (LCSW)
Entity type:Individual
Prefix:MS
First Name:JULIE
Middle Name:ANN
Last Name:KIRKES
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:JULIE
Other - Middle Name:ANN
Other - Last Name:MARKHAM/GRENKO/TRACY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:103 BODIN CIRCLE, BLD 778
Mailing Address - Street 2:VA-MENTAL HEALTH
Mailing Address - City:TRAVIS AFB
Mailing Address - State:CA
Mailing Address - Zip Code:94535
Mailing Address - Country:US
Mailing Address - Phone:707-437-1853
Mailing Address - Fax:
Practice Address - Street 1:103 BODIN CIRCLE, BLD 778
Practice Address - Street 2:VA-MENTAL HEALTH
Practice Address - City:TRAVIS AFB
Practice Address - State:CA
Practice Address - Zip Code:94535
Practice Address - Country:US
Practice Address - Phone:707-437-1853
Practice Address - Fax:916-561-7471
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-26
Last Update Date:2024-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCSW869601041C0700X
NMC-077991041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM83225102Medicaid