Healthcare Provider Details

I. General information

NPI: 1841046794
Provider Name (Legal Business Name): MISS KIMMESHRI TRACY HARRICHAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/30/2024
Last Update Date: 09/08/2026
Certification Date: 09/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2350 BUHNE ST
EUREKA CA
95501-3238
US

IV. Provider business mailing address

10940 FAIR OAKS BLVD STE 600
FAIR OAKS CA
95628-5958
US

V. Phone/Fax

Practice location:
  • Phone: 707-443-4593
  • Fax: 707-269-7116
Mailing address:
  • Phone: 916-426-2757
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number14782
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number161690
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: