Provider Demographics
NPI:1104577675
Name:HARRIS, SHANNON MARIE (LMFT)
Entity type:Individual
Prefix:
First Name:SHANNON
Middle Name:MARIE
Last Name:HARRIS
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11075 S STATE ST STE 35
Mailing Address - Street 2:
Mailing Address - City:SANDY
Mailing Address - State:UT
Mailing Address - Zip Code:84070-5187
Mailing Address - Country:US
Mailing Address - Phone:801-809-7030
Mailing Address - Fax:
Practice Address - Street 1:11075 S STATE ST STE 35
Practice Address - Street 2:
Practice Address - City:SANDY
Practice Address - State:UT
Practice Address - Zip Code:84070-5187
Practice Address - Country:US
Practice Address - Phone:801-809-7030
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-15
Last Update Date:2022-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT11109445-3902106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist