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General NPI Number Information
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NPI Number | 1194154146
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Entity Type | Individual
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Provider Name | SUMMYR NICKOLE HARRIS
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Gender | Female
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Dates
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Enumeration Date | 11/09/2013
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Last Update Date | 03/04/2025
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Provider Practice Location Address
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Address Line | 50 DEARWELL WAY
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City | SAN JOSE
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State | CA
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Zip | 95138-1608
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Country | US
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Telephone | 209-829-8039
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Fax |
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Provider Business Mailing Address
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Address Line | 2750 SUTTERVILLE RD
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City | SACRAMENTO
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State | CA
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Zip | 95820-1093
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Country | US
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Telephone | 916-452-3981
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Fax | 916-226-2804
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number | 7187
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | APCC7187
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | LPCC-16097
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License Number State | CA
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