Provider Demographics
NPI:1558781245
Name:HARRIS, DESIREE INEZ (LPCC)
Entity Type:Individual
Prefix:
First Name:DESIREE
Middle Name:INEZ
Last Name:HARRIS
Suffix:
Gender:F
Credentials:LPCC
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 30514
Mailing Address - Street 2:
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92413-0514
Mailing Address - Country:US
Mailing Address - Phone:909-269-0345
Mailing Address - Fax:
Practice Address - Street 1:600 N ARROWHEAD AVE #300
Practice Address - Street 2:
Practice Address - City:SAN BERNARDINO
Practice Address - State:CALIFORNIA
Practice Address - Zip Code:92401
Practice Address - Country:UM
Practice Address - Phone:909-763-5800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-04-21
Last Update Date:2023-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALPCC11676101YP2500X
101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional