Provider Demographics
NPI:1316747751
Name:HARRIS, ELLESABETH LEE (LAC)
Entity type:Individual
Prefix:
First Name:ELLESABETH
Middle Name:LEE
Last Name:HARRIS
Suffix:
Gender:
Credentials:LAC
Other - Prefix:
Other - First Name:ELLE
Other - Middle Name:LEE
Other - Last Name:HARRIS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2563 S VAL VISTA DR STE 108
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85295-6231
Mailing Address - Country:US
Mailing Address - Phone:480-448-1076
Mailing Address - Fax:
Practice Address - Street 1:2563 S VAL VISTA DR STE 108
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85295-6231
Practice Address - Country:US
Practice Address - Phone:480-448-1076
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-14
Last Update Date:2025-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLAC-22484101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health