Healthcare Provider Details

I. General information

NPI: 1508672379
Provider Name (Legal Business Name): SUSAN P HARRELL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/06/2024
Last Update Date: 01/05/2026
Certification Date: 01/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

768 PLEASANT VALLEY RD
DIAMOND SPRINGS CA
95619-9260
US

IV. Provider business mailing address

768 PLEASANT VALLEY RD
DIAMOND SPRINGS CA
95619-9260
US

V. Phone/Fax

Practice location:
  • Phone: 530-621-6147
  • Fax:
Mailing address:
  • Phone: 530-621-6147
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: