Provider Demographics
NPI:1427209949
Name:HARRIS, SCOTT OWEN (PHD)
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:OWEN
Last Name:HARRIS
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11980 SAN VICENTE BLVD.
Mailing Address - Street 2:SUITE 710
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90049
Mailing Address - Country:US
Mailing Address - Phone:310-422-7468
Mailing Address - Fax:310-476-4160
Practice Address - Street 1:11980 SAN VICENTE BLVD.
Practice Address - Street 2:SUITE 710
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90049
Practice Address - Country:US
Practice Address - Phone:310-422-7468
Practice Address - Fax:310-476-4160
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-02
Last Update Date:2021-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103T00000X, 103TA0400X, 103TC2200X
CAPSY8805103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TA0400XBehavioral Health & Social Service ProvidersPsychologistAddiction (Substance Use Disorder)
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent