Healthcare Provider Details

I. General information

NPI: 1740102631
Provider Name (Legal Business Name): NICOLE HARMON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/29/2026
Last Update Date: 07/29/2026
Certification Date: 07/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31200 VIA COLINAS
WESTLAKE VILLAGE CA
91362-3939
US

IV. Provider business mailing address

519 W GAINSBOROUGH RD APT 305
THOUSAND OAKS CA
91360-2447
US

V. Phone/Fax

Practice location:
  • Phone: 661-299-7079
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number163726
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: