MEDICARE: DR. SEAN BRIAN HARRIS PSYD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC2200X	Clinical Child & Adolescent Psychologist	PSY34875	CA

General Provider Information

NPI Number	:	1346616554
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SEAN BRIAN HARRIS PSYD

Provider Business Mailing Address
First Line	:	130 S B ST
Second Line	:
City	:	TUSTIN
State	:	CA
Zip	:	92780-3609
Country	:	US
Telephone Number	:	888-265-9114
Fax Number	:

Provider Business Practice Location Address
First Line	:	23120 ALICIA PKWY STE 237
Second Line	:
City	:	MISSION VIEJO
State	:	CA
Zip	:	92692-1210
Country	:	US
Telephone Number	:	949-229-5790
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/12/2015
Last Update Date	:	10/01/2024

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