Provider Demographics
NPI:1225629405
Name:HARRIS, PRISCILLA (LMFT)
Entity Type:Individual
Prefix:
First Name:PRISCILLA
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 1:17907 CALVERT ST
Mailing Address - Street 2:
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91316-7134
Mailing Address - Country:US
Mailing Address - Phone:818-970-5385
Mailing Address - Fax:
Practice Address - Street 1:17907 CALVERT ST
Practice Address - Street 2:
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91316-7134
Practice Address - Country:US
Practice Address - Phone:818-970-5385
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-29
Last Update Date:2021-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA120362106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA120362OtherLMFT