Provider Demographics
NPI:1376302067
Name:HARRIS, CARLY (LMFT)
Entity Type:Individual
Prefix:MRS
First Name:CARLY
Middle Name:
Last Name:HARRIS
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:CARLY
Other - Middle Name:
Other - Last Name:GREER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 734
Mailing Address - Street 2:
Mailing Address - City:YORBA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92885-0734
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8068 E NAPLES LN
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92808-2436
Practice Address - Country:US
Practice Address - Phone:562-713-3243
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-15
Last Update Date:2024-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA123002106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist