Provider Demographics
NPI:1316353741
Name:HARRIS, NICOLA ELIZABETH (MA)
Entity type:Individual
Prefix:
First Name:NICOLA
Middle Name:ELIZABETH
Last Name:HARRIS
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8142 WOOLBURN DR
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92646-6756
Mailing Address - Country:US
Mailing Address - Phone:714-553-1517
Mailing Address - Fax:
Practice Address - Street 1:2130 MAIN ST
Practice Address - Street 2:SUITE 120
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92648-2422
Practice Address - Country:US
Practice Address - Phone:714-553-1517
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-07
Last Update Date:2014-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC53711106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist