Provider Demographics
NPI:1316918279
Name:HARRIS, STEPHEN JAMES (PHD MFT)
Entity type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:JAMES
Last Name:HARRIS
Suffix:
Gender:M
Credentials:PHD MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23952 COPENHAGEN ST
Mailing Address - Street 2:
Mailing Address - City:MISSION VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92691-3022
Mailing Address - Country:US
Mailing Address - Phone:949-855-6675
Mailing Address - Fax:
Practice Address - Street 1:26381 CROWN VALLEY PKWY
Practice Address - Street 2:SUITE 200
Practice Address - City:MISSION VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92691-6301
Practice Address - Country:US
Practice Address - Phone:949-544-4621
Practice Address - Fax:949-716-8033
Is Sole Proprietor?:No
Enumeration Date:2006-01-30
Last Update Date:2011-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY7722103TC0700X
CAMFC17359106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAR65318Medicare ID - Type Unspecified