MEDICARE: DR. LISA B HARRIS PSY.D

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	27793	CA

General Provider Information

NPI Number	:	1588715742
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LISA B HARRIS PSY.D

Provider Business Mailing Address
First Line	:	5170 GOLDEN FOOTHILL PKWY
Second Line	:
City	:	EL DORADO HILLS
State	:	CA
Zip	:	95762-9608
Country	:	US
Telephone Number	:	916-280-5317
Fax Number	:

Provider Business Practice Location Address
First Line	:	5170 GOLDEN FOOTHILL PKWY
Second Line	:
City	:	EL DORADO HILLS
State	:	CA
Zip	:	95762-9608
Country	:	US
Telephone Number	:	916-280-5317
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/15/2007
Last Update Date	:	07/03/2019

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