Provider Demographics
NPI:1275721326
Name:HARRIS, LISA ANNE (LMFT)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:ANNE
Last Name:HARRIS
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:ANNE
Other - Last Name:SEMO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:560 E HOSPITALITY LN STE 330
Mailing Address - Street 2:
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92408-3546
Mailing Address - Country:US
Mailing Address - Phone:626-344-3350
Mailing Address - Fax:
Practice Address - Street 1:560 E HOSPITALITY LN STE 330
Practice Address - Street 2:
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92408-3546
Practice Address - Country:US
Practice Address - Phone:626-344-3350
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-10-12
Last Update Date:2023-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA54523106H00000X
CA52107106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist