Healthcare Provider Details

I. General information

NPI: 1386560027
Provider Name (Legal Business Name): MICHAEL HARRIS LMFT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/26/2026
Last Update Date: 06/26/2026
Certification Date: 06/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6627 BAY LAUREL PL BLDG 5
AVILA BEACH CA
93424-3504
US

IV. Provider business mailing address

6627 BAY LAUREL PL BLDG 5
AVILA BEACH CA
93424-3504
US

V. Phone/Fax

Practice location:
  • Phone: 760-889-9827
  • Fax:
Mailing address:
  • Phone: 760-889-9827
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL REYNOLDS HARRIS
Title or Position: OWNER/THERAPIST
Credential: LMFT
Phone: 760-889-9827