Provider Demographics
NPI:1265612477
Name:HARRIS, PATRICIA LYNN (PSY,D)
Entity type:Individual
Prefix:DR
First Name:PATRICIA
Middle Name:LYNN
Last Name:HARRIS
Suffix:
Gender:F
Credentials:PSY,D
Other - Prefix:
Other - First Name:PATRICIA
Other - Middle Name:LYNN
Other - Last Name:HARRIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PSYD
Mailing Address - Street 1:12607 SE MILL PLAIN BLVD
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98684-6055
Mailing Address - Country:US
Mailing Address - Phone:855-632-8280
Mailing Address - Fax:
Practice Address - Street 1:12636 SE STARK ST., PLAZA 125, BUILDING J
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97233
Practice Address - Country:US
Practice Address - Phone:503-253-4600
Practice Address - Fax:503-233-4609
Is Sole Proprietor?:No
Enumeration Date:2007-11-06
Last Update Date:2021-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1731103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical