Provider Demographics
NPI:1477677607
Name:GRANT, JULIA MARIE (MHA)
Entity Type:Individual
Prefix:MR
First Name:JULIA
Middle Name:MARIE
Last Name:GRANT
Suffix:
Gender:F
Credentials:MHA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5527 JON DODSON DR
Mailing Address - Street 2:
Mailing Address - City:AGOURA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91301-2063
Mailing Address - Country:US
Mailing Address - Phone:818-889-4030
Mailing Address - Fax:
Practice Address - Street 1:125 W THOUSAND OAKS BLVD STE 500
Practice Address - Street 2:
Practice Address - City:THOUSAND OAKS
Practice Address - State:CA
Practice Address - Zip Code:91360-4462
Practice Address - Country:US
Practice Address - Phone:805-777-3500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-16
Last Update Date:2022-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA101Y00000X
CA51788101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor