Healthcare Provider Details

I. General information

NPI: 1104859982
Provider Name (Legal Business Name): SHIRLEY HARMON PSY.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/08/2006
Last Update Date: 07/21/2022
Certification Date: 08/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 W SANTA ANA BLVD STE 801
SANTA ANA CA
92701-4134
US

IV. Provider business mailing address

200 W SANTA ANA BLVD STE 801
SANTA ANA CA
92701-4134
US

V. Phone/Fax

Practice location:
  • Phone: 714-704-5900
  • Fax: 714-978-3419
Mailing address:
  • Phone: 714-704-5900
  • Fax: 714-978-3419

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY20198
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: