Provider Demographics
NPI:1467086082
Name:HARRISS, MELANIE JOY (BSN, MA, LMFT)
Entity Type:Individual
Prefix:
First Name:MELANIE
Middle Name:JOY
Last Name:HARRISS
Suffix:
Gender:F
Credentials:BSN, MA, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 78302
Mailing Address - Street 2:
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92877-0143
Mailing Address - Country:US
Mailing Address - Phone:951-314-2272
Mailing Address - Fax:
Practice Address - Street 1:341 MAGNOLIA AVE STE 102
Practice Address - Street 2:
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:92879-3331
Practice Address - Country:US
Practice Address - Phone:951-523-7311
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-24
Last Update Date:2022-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALMFT130484106H00000X
CALMFT46876106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist