Healthcare Provider Details

I. General information

NPI: 1013217041
Provider Name (Legal Business Name): HARMONEE ISENBARGER-ELLIS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/25/2010
Last Update Date: 07/22/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 EMPIRE ST
FAIRFIELD CA
94533-5702
US

IV. Provider business mailing address

355 TUOLUMNE ST
VALLEJO CA
94590-5700
US

V. Phone/Fax

Practice location:
  • Phone: 707-425-5744
  • Fax:
Mailing address:
  • Phone: 707-553-5810
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: