Healthcare Provider Details

I. General information

NPI: 1386465300
Provider Name (Legal Business Name): TAMARA HARRISON MS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/22/2024
Last Update Date: 08/17/2026
Certification Date: 08/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3525 DEL MAR HEIGHTS RD # 999
SAN DIEGO CA
92130-2199
US

IV. Provider business mailing address

3525 DEL MAR HEIGHTS RD # 999
SAN DIEGO CA
92130-2199
US

V. Phone/Fax

Practice location:
  • Phone: 415-335-6715
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number15391
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number161088
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: