MEDICARE: MR. DONALD WAYNE HARRIS LMFT

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	106H00000X	Marriage & Family Therapist	80311	CA

General Provider Information

NPI Number	:	1346754322
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. DONALD WAYNE HARRIS LMFT

Provider Business Mailing Address
First Line	:	PO BOX 2110
Second Line	:
City	:	LAGUNA HILLS
State	:	CA
Zip	:	92654-2110
Country	:	US
Telephone Number	:	714-310-5283
Fax Number	:

Provider Business Practice Location Address
First Line	:	3151 AIRWAY AVE STE A2
Second Line	:
City	:	COSTA MESA
State	:	CA
Zip	:	92626-4620
Country	:	US
Telephone Number	:	714-696-8253
Fax Number	:

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

Provider Enumeration Date	:	11/28/2017
Last Update Date	:	07/21/2024

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