Healthcare Provider Details

I. General information

NPI: 1518897099
Provider Name (Legal Business Name): MIA MICHELLE HARKNESS AMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/19/2026
Last Update Date: 05/19/2026
Certification Date: 05/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1910 OLYMPIC BLVD STE 365
WALNUT CREEK CA
94596-5096
US

IV. Provider business mailing address

4675 W 131ST ST # A
HAWTHORNE CA
90250-5106
US

V. Phone/Fax

Practice location:
  • Phone: 877-676-7634
  • Fax: 877-676-7634
Mailing address:
  • Phone: 877-676-7634
  • Fax: 877-676-7634

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberAMFT147551
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: