=====================================================
General NPI Number Information
=====================================================
NPI Number | 1497205983
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | PATRICE GRAHAM-HARDEN
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/07/2016
-----------------------------------------------------
Last Update Date | 09/08/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5201 GREAT AMERICA PKWY STE 320
-----------------------------------------------------
City | SANTA CLARA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95054-1140
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 323-205-7088
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1569 FLYNN RD APT 8204
-----------------------------------------------------
City | CAMARILLO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93012-5827
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 951-531-7474
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
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 | 151142
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------