Provider Demographics
NPI:1952022162
Name:HARRIS, JAMESRIA A (LAC)
Entity Type:Individual
Prefix:
First Name:JAMESRIA
Middle Name:A
Last Name:HARRIS
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:JAM
Other - Middle Name:
Other - Last Name:HARRIS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LAC
Mailing Address - Street 1:7141 W CARTER RD
Mailing Address - Street 2:
Mailing Address - City:LAVEEN
Mailing Address - State:AZ
Mailing Address - Zip Code:85339-7059
Mailing Address - Country:US
Mailing Address - Phone:503-890-0311
Mailing Address - Fax:480-781-4566
Practice Address - Street 1:3930 N 30TH AVE
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85017-4607
Practice Address - Country:US
Practice Address - Phone:623-322-6143
Practice Address - Fax:480-781-4566
Is Sole Proprietor?:No
Enumeration Date:2022-09-06
Last Update Date:2022-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLAC19969101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ091903Medicaid