Provider Demographics
NPI:1093313850
Name:HARRIS, LAVAREZ DELL (EDD, LMFT, CLC)
Entity Type:Individual
Prefix:DR
First Name:LAVAREZ
Middle Name:DELL
Last Name:HARRIS
Suffix:
Gender:F
Credentials:EDD, LMFT, CLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16772 W BELL RD STE 110-284
Mailing Address - Street 2:
Mailing Address - City:SURPRISE
Mailing Address - State:AZ
Mailing Address - Zip Code:85374-9702
Mailing Address - Country:US
Mailing Address - Phone:949-677-9740
Mailing Address - Fax:
Practice Address - Street 1:26641 W MATTHEW DR
Practice Address - Street 2:
Practice Address - City:BUCKEYE
Practice Address - State:AZ
Practice Address - Zip Code:85396-8011
Practice Address - Country:US
Practice Address - Phone:949-275-4499
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-14
Last Update Date:2020-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ15383106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty