MEDICARE: DR. JENNIFER HARRIS LMFT, BCBA-D

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	41359	CA
2	103K00000X	Behavior Analyst	1-08-4153	CA

General Provider Information

NPI Number	:	1780020594
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JENNIFER HARRIS LMFT, BCBA-D

Provider Business Mailing Address
First Line	:	119 W TORRANCE BLVD STE 100
Second Line	:
City	:	REDONDO BEACH
State	:	CA
Zip	:	90277-3600
Country	:	US
Telephone Number	:	310-374-3300
Fax Number	:

Provider Business Practice Location Address
First Line	:	2447 PACIFIC COAST HWY
Second Line	:	SUITE 111
City	:	HERMOSA BEACH
State	:	CA
Zip	:	90254-2714
Country	:	US
Telephone Number	:	310-374-3300
Fax Number	:	310-374-3307

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

Provider Enumeration Date	:	05/20/2013
Last Update Date	:	06/20/2022

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