Healthcare Provider Details

I. General information

NPI: 1447161765
Provider Name (Legal Business Name): MIKAH HARLEY AMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/15/2026
Last Update Date: 09/15/2026
Certification Date: 09/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2333 COURAGE DR STE E
FAIRFIELD CA
94533-6715
US

IV. Provider business mailing address

2333 COURAGE DR STE E
FAIRFIELD CA
94533-6715
US

V. Phone/Fax

Practice location:
  • Phone: 916-840-1606
  • Fax:
Mailing address:
  • Phone: 916-840-1606
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number164030
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: