=====================================================
General NPI Number Information
=====================================================
NPI Number | 1356439186
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | HARVA KENDRICK MFT
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/10/2006
-----------------------------------------------------
Last Update Date | 08/12/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2133 SHOSHONE CIR
-----------------------------------------------------
City | DANVILLE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94526-5547
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 925-831-8100
-----------------------------------------------------
Fax | 925-804-6384
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2133 SHOSHONE CIR
-----------------------------------------------------
City | DANVILLE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94526-5547
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 925-831-8100
-----------------------------------------------------
Fax | 925-804-6384
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 106H00000X
-----------------------------------------------------
Taxonomy Name | Marriage & Family Therapist
-----------------------------------------------------
License Number | MFC28667
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------