Healthcare Provider Details

I. General information

NPI: 1225204563
Provider Name (Legal Business Name): KIMBERLY ANN HARRIS MFT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/06/2008
Last Update Date: 09/01/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

720 WOOD ST
EUREKA CA
95501-4413
US

IV. Provider business mailing address

475 FOREST AVE
ARCATA CA
95521-4909
US

V. Phone/Fax

Practice location:
  • Phone: 707-268-2990
  • Fax:
Mailing address:
  • Phone: 707-441-5220
  • Fax: 707-441-5667

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMFC29064
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: