Provider Demographics
NPI:1619061215
Name:HARRIS, LANA (MA)
Entity Type:Individual
Prefix:
First Name:LANA
Middle Name:
Last Name:HARRIS
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5380 HOLIDAY TERRACE
Mailing Address - Street 2:SUITE 34
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49009-2128
Mailing Address - Country:US
Mailing Address - Phone:269-353-1600
Mailing Address - Fax:269-353-1601
Practice Address - Street 1:5380 HOLIDAY TERRACE
Practice Address - Street 2:SUITE 34
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49009-2128
Practice Address - Country:US
Practice Address - Phone:269-353-1600
Practice Address - Fax:269-353-1601
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401001189101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional