Healthcare Provider Details

I. General information

NPI: 1255296620
Provider Name (Legal Business Name): CORINNE MARIE HARRIS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/18/2025
Last Update Date: 12/18/2025
Certification Date: 12/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7801 FOLSOM BLVD STE 215
SACRAMENTO CA
95826-2620
US

IV. Provider business mailing address

PO BOX 1062
ROSEVILLE CA
95678-8062
US

V. Phone/Fax

Practice location:
  • Phone: 916-376-7935
  • Fax:
Mailing address:
  • Phone: 916-790-0741
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number155754
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: