MEDICARE: SUSAN P HARRELL

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106H00000X	Marriage & Family Therapist		CA
2	101YP2500X	Professional Counselor

General Provider Information

NPI Number	:	1508672379
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUSAN P HARRELL

Provider Business Mailing Address
First Line	:	768 PLEASANT VALLEY RD
Second Line	:
City	:	DIAMOND SPRINGS
State	:	CA
Zip	:	95619-9260
Country	:	US
Telephone Number	:	530-621-6147
Fax Number	:

Provider Business Practice Location Address
First Line	:	768 PLEASANT VALLEY RD
Second Line	:
City	:	DIAMOND SPRINGS
State	:	CA
Zip	:	95619-9260
Country	:	US
Telephone Number	:	530-621-6147
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/06/2024
Last Update Date	:	01/05/2026

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Directions to “ SUSAN P HARRELL ” Practice Location

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