Provider Demographics
NPI:1558850826
Name:HARRISON, BRENT SCOTT (MA, MFT)
Entity Type:Individual
Prefix:
First Name:BRENT
Middle Name:SCOTT
Last Name:HARRISON
Suffix:
Gender:M
Credentials:MA, MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20830 STEVENS CREEK BLVD # 1137
Mailing Address - Street 2:
Mailing Address - City:CUPERTINO
Mailing Address - State:CA
Mailing Address - Zip Code:95014-2121
Mailing Address - Country:US
Mailing Address - Phone:669-609-0132
Mailing Address - Fax:
Practice Address - Street 1:236 N SANTA CRUZ AVE STE 249
Practice Address - Street 2:
Practice Address - City:LOS GATOS
Practice Address - State:CA
Practice Address - Zip Code:95030-7262
Practice Address - Country:US
Practice Address - Phone:209-788-3627
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-02
Last Update Date:2023-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA140337106H00000X
CAAMFT105762106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist