Provider Demographics
NPI:1740456896
Name:HARISH, SURINDER K (LMFT)
Entity type:Individual
Prefix:MR
First Name:SURINDER
Middle Name:K
Last Name:HARISH
Suffix:
Gender:M
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:PO BOX 15156
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94539-2256
Mailing Address - Country:US
Mailing Address - Phone:408-916-3490
Mailing Address - Fax:
Practice Address - Street 1:3015 HOPYARD RD STE O
Practice Address - Street 2:
Practice Address - City:PLEASANTON
Practice Address - State:CA
Practice Address - Zip Code:94588-5254
Practice Address - Country:US
Practice Address - Phone:408-916-3490
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-07
Last Update Date:2014-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALMFT 80118106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist