Provider Demographics
NPI:1457024234
Name:HARRIS, TIMOTHY (PSYCH TECH)
Entity Type:Individual
Prefix:MR
First Name:TIMOTHY
Middle Name:
Last Name:HARRIS
Suffix:
Gender:M
Credentials:PSYCH TECH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6110 GARFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95841-2009
Mailing Address - Country:US
Mailing Address - Phone:916-642-7800
Mailing Address - Fax:
Practice Address - Street 1:6110 GARFIELD AVE
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95841-2009
Practice Address - Country:US
Practice Address - Phone:916-642-7800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-28
Last Update Date:2021-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT36437167G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes167G00000XNursing Service ProvidersLicensed Psychiatric Technician