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General NPI Number Information
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NPI Number | 1891030474
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Entity Type | Individual
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Provider Name | EDWIN GIZELTER HARRIS LMFT
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Gender | Male
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Dates
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Enumeration Date | 12/07/2012
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Last Update Date | 12/07/2012
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Provider Practice Location Address
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Address Line | 3031 TELEGRAPH AVE
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City | OAKLAND
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State | CA
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Zip | 94609-3205
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Country | US
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Telephone | 510-596-8125
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Fax | 510-281-6100
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Provider Business Mailing Address
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Address Line | 1310 D. ADDISON STREET
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City | BERKELEY
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State | CA
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Zip | 94702-1733
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Country | US
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Telephone | 510-849-2535
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 50856
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License Number State | CA
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