Provider Demographics
NPI:1720461841
Name:HARRIS-FITZSIMONS, EVIE LEE
Entity type:Individual
Prefix:
First Name:EVIE
Middle Name:LEE
Last Name:HARRIS-FITZSIMONS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:EVIE
Other - Middle Name:LEE
Other - Last Name:HARRIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:AMFT
Mailing Address - Street 1:PO BOX 4330
Mailing Address - Street 2:
Mailing Address - City:SONORA
Mailing Address - State:CA
Mailing Address - Zip Code:95370-1330
Mailing Address - Country:US
Mailing Address - Phone:209-217-4178
Mailing Address - Fax:209-532-5003
Practice Address - Street 1:531 S WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:SONORA
Practice Address - State:CA
Practice Address - Zip Code:95370-5114
Practice Address - Country:US
Practice Address - Phone:209-217-4178
Practice Address - Fax:209-532-5003
Is Sole Proprietor?:No
Enumeration Date:2015-07-07
Last Update Date:2024-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA144499106H00000X
CA98616106H00000X
106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist