Provider Demographics
NPI:1851478960
Name:THERESA L. HARRIS
Entity Type:Organization
Organization Name:THERESA L. HARRIS
Other - Org Name:MINDFUL LIVING COUNSELING SERVICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MARRIAGE AND FAMILY THERAPIST
Authorized Official - Prefix:MS
Authorized Official - First Name:THERESA
Authorized Official - Middle Name:LYNETTE
Authorized Official - Last Name:HARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:M S
Authorized Official - Phone:909-902-1868
Mailing Address - Street 1:PO BOX 27633
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92809-0121
Mailing Address - Country:US
Mailing Address - Phone:909-902-1868
Mailing Address - Fax:909-902-1868
Practice Address - Street 1:12540 10TH ST
Practice Address - Street 2:SUITE C
Practice Address - City:CHINO
Practice Address - State:CA
Practice Address - Zip Code:91710-3503
Practice Address - Country:US
Practice Address - Phone:909-902-1868
Practice Address - Fax:909-902-1868
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2009-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC39896106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty