Healthcare Provider Details

I. General information

NPI: 1164916029
Provider Name (Legal Business Name): EBONY AYANA HARRIS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2018
Last Update Date: 03/18/2026
Certification Date: 03/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4900 CALIFORNIA AVE
BAKERSFIELD CA
93309-7024
US

IV. Provider business mailing address

PO BOX 22592
BAKERSFIELD CA
93390-2592
US

V. Phone/Fax

Practice location:
  • Phone: 855-323-2700
  • Fax:
Mailing address:
  • Phone: 661-619-8913
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number140568
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number5029-R
License Number StateNV
# 4
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number119767
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: