Provider Demographics
NPI:1457739328
Name:JULIE KIRKES
Entity type:Organization
Organization Name:JULIE KIRKES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:
Authorized Official - Last Name:TRACY
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:575-642-0984
Mailing Address - Street 1:PO BOX 2344
Mailing Address - Street 2:
Mailing Address - City:NORTH HIGHLANDS
Mailing Address - State:CA
Mailing Address - Zip Code:95660-8344
Mailing Address - Country:US
Mailing Address - Phone:575-642-0984
Mailing Address - Fax:
Practice Address - Street 1:5342 DUDLEY BLVD.
Practice Address - Street 2:MCCL/116
Practice Address - City:MCCLELLAN
Practice Address - State:CA
Practice Address - Zip Code:95652
Practice Address - Country:US
Practice Address - Phone:916-561-7627
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-12
Last Update Date:2019-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMC-07799251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM15204278Medicaid