Provider Demographics
NPI:1164438958
Name:HARPER, MOLLY MARTHA (MA MFTINTERN)
Entity Type:Individual
Prefix:
First Name:MOLLY
Middle Name:MARTHA
Last Name:HARPER
Suffix:
Gender:F
Credentials:MA MFTINTERN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4005 MANZANITA AVE STE 6
Mailing Address - Street 2:#125
Mailing Address - City:CARMICHAEL
Mailing Address - State:CA
Mailing Address - Zip Code:95608-1779
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5777 MADISON AVE.
Practice Address - Street 2:STE 240
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95841
Practice Address - Country:US
Practice Address - Phone:916-344-0964
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA42605106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA000008462OtherMED-ICAL PROVIDER #