Provider Demographics
NPI:1922540053
Name:HARRISON, SUSAN L (LMFT)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:L
Last Name:HARRISON
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2067 MARYAL DRIVE
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95864
Mailing Address - Country:US
Mailing Address - Phone:916-230-7192
Mailing Address - Fax:
Practice Address - Street 1:2067 MARYAL DRIVE
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95864
Practice Address - Country:US
Practice Address - Phone:916-230-7192
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-07
Last Update Date:2024-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA93612106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CALMFT 93612OtherLICENSED MARRIAGE AND FAMILY THERAPIST