MEDICARE: JANEE NICHOLE HARRIS

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	101YM0800X	Mental Health Counselor
2	101YM0800X	Mental Health Counselor	61103	CA

General Provider Information

NPI Number	:	1780717264
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JANEE NICHOLE HARRIS

Provider Business Mailing Address
First Line	:	505 S GLENHURST DR
Second Line	:
City	:	ANAHEIM
State	:	CA
Zip	:	92808-1925
Country	:	US
Telephone Number	:	619-733-3089
Fax Number	:

Provider Business Practice Location Address
First Line	:	505 SOUTH GLENHURST DRIVE
Second Line	:
City	:	ANAHEIM HILLS
State	:	CA
Zip	:	92808-3608
Country	:	US
Telephone Number	:	619-733-3089
Fax Number	:

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

Provider Enumeration Date	:	03/13/2007
Last Update Date	:	08/14/2012

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