Provider Demographics
NPI:1851600514
Name:HARRIS, BRANDY ALEXANDRIA
Entity Type:Individual
Prefix:MRS
First Name:BRANDY
Middle Name:ALEXANDRIA
Last Name:HARRIS
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:BRANDY
Other - Middle Name:ALEXANDRIA
Other - Last Name:HERBERT-HARRIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MFTI
Mailing Address - Street 1:8736 RAMONA ST
Mailing Address - Street 2:
Mailing Address - City:BELLFLOWER
Mailing Address - State:CA
Mailing Address - Zip Code:90706-7714
Mailing Address - Country:US
Mailing Address - Phone:310-493-2221
Mailing Address - Fax:
Practice Address - Street 1:5150 CANDLEWOOD ST STE 16F
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CA
Practice Address - Zip Code:90712-1927
Practice Address - Country:US
Practice Address - Phone:323-546-9838
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-29
Last Update Date:2019-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CA104817106H00000X
CA69124106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program