Provider Demographics
NPI:1841517828
Name:HARRIS, STACY L (MFT)
Entity type:Individual
Prefix:
First Name:STACY
Middle Name:L
Last Name:HARRIS
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 1:1725 OREGON ST
Mailing Address - Street 2:
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96001-1718
Mailing Address - Country:US
Mailing Address - Phone:530-242-6012
Mailing Address - Fax:530-223-1370
Practice Address - Street 1:1725 OREGON ST
Practice Address - Street 2:
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96001-1718
Practice Address - Country:US
Practice Address - Phone:530-242-6012
Practice Address - Fax:530-223-1370
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-29
Last Update Date:2010-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 48155106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist