Provider Demographics
NPI:1053669564
Name:HARRIS, WENDY (PSYD)
Entity Type:Individual
Prefix:DR
First Name:WENDY
Middle Name:
Last Name:HARRIS
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17350 W SUNSET BLVD
Mailing Address - Street 2:103C
Mailing Address - City:PACIFIC PALISADES
Mailing Address - State:CA
Mailing Address - Zip Code:90272-4111
Mailing Address - Country:US
Mailing Address - Phone:323-836-5793
Mailing Address - Fax:
Practice Address - Street 1:17350 W SUNSET BLVD
Practice Address - Street 2:103C
Practice Address - City:PACIFIC PALISADES
Practice Address - State:CA
Practice Address - Zip Code:90272-4111
Practice Address - Country:US
Practice Address - Phone:323-836-5793
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-15
Last Update Date:2016-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSB94022080103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical