Healthcare Provider Details

I. General information

NPI: 1164225892
Provider Name (Legal Business Name): ABUNDANT LIFE THERAPEUTIC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/28/2025
Last Update Date: 02/24/2026
Certification Date: 02/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2508 GARFIELD AVE STE F
CARMICHAEL CA
95608-4796
US

IV. Provider business mailing address

2508 GARFIELD AVE STE F
CARMICHAEL CA
95608-4796
US

V. Phone/Fax

Practice location:
  • Phone: 916-520-4038
  • Fax:
Mailing address:
  • Phone: 916-520-4038
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: MRS. SUMMYR HARRIS
Title or Position: CEO
Credential: LPCC
Phone: 916-520-4038