Healthcare Provider Details

I. General information

NPI: 1609899483
Provider Name (Legal Business Name): MARCUS DUSTIN HARRIS MA, LMFT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/25/2006
Last Update Date: 04/20/2026
Certification Date: 04/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4501 BANNISTER RD
FAIR OAKS CA
95628-5703
US

IV. Provider business mailing address

5304 ELGIN HILLS WAY
ANTELOPE CA
95843-5927
US

V. Phone/Fax

Practice location:
  • Phone: 916-971-5221
  • Fax:
Mailing address:
  • Phone: 916-721-1337
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberLMFT #42495
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: