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NPI Code Detail

MEDICARE: MR. TIMOTHY HARRIS PSYCH TECH

MEDICARE: MR. TIMOTHY HARRIS PSYCH TECH
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1167G00000XLicensed Psychiatric TechnicianPT36437CA

General Provider Information

NPI Number : 1457024234
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. TIMOTHY HARRIS PSYCH TECH
Provider Business Mailing Address
First Line : 6110 GARFIELD AVE
Second Line :
City : SACRAMENTO
State : CA
Zip : 95841-2009
Country : US
Telephone Number : 916-642-7800
Fax Number :
Provider Business Practice Location Address
First Line : 6110 GARFIELD AVE
Second Line :
City : SACRAMENTO
State : CA
Zip : 95841-2009
Country : US
Telephone Number : 916-642-7800
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/28/2021
Last Update Date : 07/28/2021

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