Provider Demographics
NPI:1184921108
Name:HARRIS, TARA SCHERON
Entity type:Individual
Prefix:
First Name:TARA
Middle Name:SCHERON
Last Name:HARRIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11927 ELLIOTT AVE
Mailing Address - Street 2:
Mailing Address - City:EL MONTE
Mailing Address - State:CA
Mailing Address - Zip Code:91732-3740
Mailing Address - Country:US
Mailing Address - Phone:626-350-5304
Mailing Address - Fax:626-350-0756
Practice Address - Street 1:11927 ELLIOTT AVE
Practice Address - Street 2:
Practice Address - City:EL MONTE
Practice Address - State:CA
Practice Address - Zip Code:91732-3740
Practice Address - Country:US
Practice Address - Phone:626-350-5304
Practice Address - Fax:626-350-0756
Is Sole Proprietor?:No
Enumeration Date:2011-02-28
Last Update Date:2011-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health