MEDICARE: SHAYLA C HARRIS

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	101YA0400X	Addiction (Substance Use Disorder) Counselor		CA

General Provider Information

NPI Number	:	1558818039
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHAYLA C HARRIS

Provider Business Mailing Address
First Line	:	9355 EAST STOCKTON BLVD
Second Line	:
City	:	ELK GROVE
State	:	CA
Zip	:	95624
Country	:	US
Telephone Number	:	916-714-5400
Fax Number	:	916-714-6900

Provider Business Practice Location Address
First Line	:	9355 E STOCKTON BLVD
Second Line	:
City	:	ELK GROVE
State	:	CA
Zip	:	95624-9476
Country	:	US
Telephone Number	:	916-714-5400
Fax Number	:	916-714-6900

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

Provider Enumeration Date	:	09/01/2016
Last Update Date	:	09/01/2016

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