Provider Demographics
NPI:1457361008
Name:HARRIS, DENNIS LEE
Entity type:Individual
Prefix:MR
First Name:DENNIS
Middle Name:LEE
Last Name:HARRIS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2912 BIG CREEK LN
Mailing Address - Street 2:
Mailing Address - City:ONTARIO
Mailing Address - State:CA
Mailing Address - Zip Code:91761-0267
Mailing Address - Country:US
Mailing Address - Phone:909-635-2055
Mailing Address - Fax:909-635-2044
Practice Address - Street 1:8300 UTICA AVE FL 3
Practice Address - Street 2:
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91730-3879
Practice Address - Country:US
Practice Address - Phone:909-635-2055
Practice Address - Fax:909-635-2044
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA15326106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist