Provider Demographics
NPI:1801445929
Name:JULIET ACOLATSE
Entity type:Organization
Organization Name:JULIET ACOLATSE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JULIET
Authorized Official - Middle Name:
Authorized Official - Last Name:ACOLATSE
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:209-855-1006
Mailing Address - Street 1:1201 N SUTTER ST
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95202-1506
Mailing Address - Country:US
Mailing Address - Phone:209-855-1006
Mailing Address - Fax:209-408-1160
Practice Address - Street 1:1201 N SUTTER ST
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95202-1506
Practice Address - Country:US
Practice Address - Phone:209-855-1006
Practice Address - Fax:209-408-1160
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-11
Last Update Date:2020-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental HealthGroup - Single Specialty
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health