Provider Demographics
NPI:1033348420
Name:HARRIS, GAIL (LMFT)
Entity Type:Individual
Prefix:
First Name:GAIL
Middle Name:
Last Name:HARRIS
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1096 CALIMESA BLVD
Mailing Address - Street 2:BLDG #D STE #212
Mailing Address - City:CALIMESA
Mailing Address - State:CA
Mailing Address - Zip Code:92320-1563
Mailing Address - Country:US
Mailing Address - Phone:909-633-6652
Mailing Address - Fax:951-780-7294
Practice Address - Street 1:1096 CALIMESA BLVD
Practice Address - Street 2:BLDG #D STE #212
Practice Address - City:CALIMESA
Practice Address - State:CA
Practice Address - Zip Code:92320-1563
Practice Address - Country:US
Practice Address - Phone:909-633-6652
Practice Address - Fax:951-780-7294
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-07
Last Update Date:2009-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC46912106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist