Provider Demographics
NPI:1457596538
Name:HARPER, VANESSA AILEEN (MFT)
Entity Type:Individual
Prefix:MS
First Name:VANESSA
Middle Name:AILEEN
Last Name:HARPER
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:161 FASHION LN STE 150
Mailing Address - Street 2:
Mailing Address - City:TUSTIN
Mailing Address - State:CA
Mailing Address - Zip Code:92780-3325
Mailing Address - Country:US
Mailing Address - Phone:949-683-2426
Mailing Address - Fax:
Practice Address - Street 1:161 FASHION LN STE 150
Practice Address - Street 2:
Practice Address - City:TUSTIN
Practice Address - State:CA
Practice Address - Zip Code:92780-3325
Practice Address - Country:US
Practice Address - Phone:949-683-2426
Practice Address - Fax:714-744-8775
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-03
Last Update Date:2022-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 43781106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist