Provider Demographics
NPI:1639423296
Name:HARRIS, DANIELLA ELAINE (MA)
Entity type:Individual
Prefix:MRS
First Name:DANIELLA
Middle Name:ELAINE
Last Name:HARRIS
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10000 WATSON RD.
Mailing Address - Street 2:SUITE 1L3
Mailing Address - City:ST. LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63126-1843
Mailing Address - Country:US
Mailing Address - Phone:314-843-0043
Mailing Address - Fax:314-843-0201
Practice Address - Street 1:10000 WATSON RD.
Practice Address - Street 2:SUITE 1L3
Practice Address - City:ST. LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63126-1843
Practice Address - Country:US
Practice Address - Phone:314-843-0043
Practice Address - Fax:314-843-0201
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-05
Last Update Date:2012-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2012037398101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional