Healthcare Provider Details

I. General information

NPI: 1730210873
Provider Name (Legal Business Name): MISTI LYNNE HARRIS MA, MFTI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/08/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

951 BLANCO CIR STE B
SALINAS CA
93901-4451
US

IV. Provider business mailing address

951 BLANCO CIR STE B
SALINAS CA
93901-4451
US

V. Phone/Fax

Practice location:
  • Phone: 831-784-2150
  • Fax:
Mailing address:
  • Phone: 831-784-2150
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberIMF 49646
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: