Active NPI
Kimberly Grace
- Addiction (Substance Use Disorder) Counselor
- Modesto, CA
National Provider Identifier
1760686307
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Addiction (Substance Use Disorder) Counselor
- Practice address
- 948 11TH St
Suite 20
Modesto, CA 95354-2308 - Phone
- (209) 579-1151
- Fax
- (209) 579-9605
- NPI assigned
- Jun 14, 2007
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | Primary |
Addresses
Primary practice location
948 11TH St
Suite 20
Modesto, CA 95354-2308
Mailing address
948 11TH St
Suite 20
Modesto, CA 95354-2308
Phone (209) 579-1151
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 101YA040OX | Other | CA | ADDICTION COUNSELOR |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1181779200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1760686307",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "948 11TH ST",
"address_2": "SUITE 20",
"city": "MODESTO",
"state": "CA",
"postal_code": "953542308",
"telephone_number": "209-579-1151",
"fax_number": "209-579-9605"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "948 11TH ST",
"address_2": "SUITE 20",
"city": "MODESTO",
"state": "CA",
"postal_code": "953542308",
"telephone_number": "209-579-1151",
"fax_number": "209-579-9605"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GRACE",
"first_name": "KIMBERLY",
"name_prefix": "Ms.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-06-14",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "101YA0400X",
"taxonomy_group": "",
"desc": "Counselor, Addiction (Substance Use Disorder)",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "ADDICTION COUNSELOR",
"identifier": "101YA040OX",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Modesto, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.