Provider Demographics
NPI:1396880811
Name:HARRIS, BETTY LORRAINE
Entity type:Individual
Prefix:MRS
First Name:BETTY
Middle Name:LORRAINE
Last Name:HARRIS
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:BETTY
Other - Middle Name:LORRAINE
Other - Last Name:HARRIS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:2784 E MAGILL AVE
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93710-4817
Mailing Address - Country:US
Mailing Address - Phone:559-323-0279
Mailing Address - Fax:559-486-3146
Practice Address - Street 1:405 N BROADWAY ST
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93701-1513
Practice Address - Country:US
Practice Address - Phone:559-486-3146
Practice Address - Fax:559-486-3146
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACAS #1175101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)