Provider Demographics
NPI:1114030244
Name:HARKER, SUSAN LEIANN (PSYD)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:LEIANN
Last Name:HARKER
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:DR
Other - First Name:S
Other - Middle Name:LEIANN
Other - Last Name:HARKER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PSYD
Mailing Address - Street 1:8786 CYPRESS AVENUE
Mailing Address - Street 2:
Mailing Address - City:CYPRESS
Mailing Address - State:CA
Mailing Address - Zip Code:90630
Mailing Address - Country:US
Mailing Address - Phone:714-652-3637
Mailing Address - Fax:
Practice Address - Street 1:10601 WALKER ST 220
Practice Address - Street 2:
Practice Address - City:CYPRESS
Practice Address - State:CA
Practice Address - Zip Code:90630-4733
Practice Address - Country:US
Practice Address - Phone:714-652-3637
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-15
Last Update Date:2015-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY10332103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPSY103320Medicaid
CAPSY10332OtherVALUE OPTIONS
CA073496OtherMANAGED HEALTH NETWORK
CAPSY10332OtherPACIFICARE BEHAVIORAL
CAPSY103320Medicaid