Provider Demographics
NPI:1376298992
Name:HARRIS, TERRA RENEE
Entity Type:Individual
Prefix:
First Name:TERRA
Middle Name:RENEE
Last Name:HARRIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 N YALE ST APT 113
Mailing Address - Street 2:
Mailing Address - City:HEMET
Mailing Address - State:CA
Mailing Address - Zip Code:92544-4794
Mailing Address - Country:US
Mailing Address - Phone:951-484-6758
Mailing Address - Fax:
Practice Address - Street 1:200 N YALE ST APT 113
Practice Address - Street 2:
Practice Address - City:HEMET
Practice Address - State:CA
Practice Address - Zip Code:92544-4794
Practice Address - Country:US
Practice Address - Phone:951-484-6758
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-14
Last Update Date:2022-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE1762441101YS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool