=====================================================
General NPI Number Information
=====================================================
NPI Number | 1699736884
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KENT CHRISTOPHER HARRIS PHD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/29/2006
-----------------------------------------------------
Last Update Date | 11/07/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1194 E WALNUT ST
-----------------------------------------------------
City | PASADENA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91106-1845
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 626-580-4335
-----------------------------------------------------
Fax | 626-445-2440
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 592 SUNSET DR
-----------------------------------------------------
City | ALTADENA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91001-1446
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 626-445-2440
-----------------------------------------------------
Fax | 626-445-2440
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103T00000X
-----------------------------------------------------
Taxonomy Name | Psychologist
-----------------------------------------------------
License Number | PSY18137
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------