Provider Demographics
NPI:1629795695
Name:HARRELL, ANASTASIA ELAINA (PSYD)
Entity Type:Individual
Prefix:DR
First Name:ANASTASIA
Middle Name:ELAINA
Last Name:HARRELL
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 EL NIDO AVE APT 69
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91107-4489
Mailing Address - Country:US
Mailing Address - Phone:805-358-0246
Mailing Address - Fax:
Practice Address - Street 1:625 FAIR OAKS AVE STE 101
Practice Address - Street 2:
Practice Address - City:SOUTH PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91030-2685
Practice Address - Country:US
Practice Address - Phone:626-765-4482
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-20
Last Update Date:2022-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA33553103G00000X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist