Provider Demographics
NPI:1609899483
Name:HARRIS, MARCUS DUSTIN (MA, LMFT)
Entity Type:Individual
Prefix:
First Name:MARCUS
Middle Name:DUSTIN
Last Name:HARRIS
Suffix:
Gender:M
Credentials:MA, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5304 ELGIN HILLS WAY
Mailing Address - Street 2:
Mailing Address - City:ANTELOPE
Mailing Address - State:CA
Mailing Address - Zip Code:95843-5927
Mailing Address - Country:US
Mailing Address - Phone:916-721-1337
Mailing Address - Fax:
Practice Address - Street 1:5750 SUNRISE BLVD
Practice Address - Street 2:
Practice Address - City:CITRUS HEIGHTS
Practice Address - State:CA
Practice Address - Zip Code:95610-7634
Practice Address - Country:US
Practice Address - Phone:916-344-0964
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2011-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALMFT #42495106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA000008462OtherMEDICAL PROVIDER NUMBER