Provider Demographics
NPI:1699736884
Name:HARRIS, KENT CHRISTOPHER (PHD)
Entity type:Individual
Prefix:DR
First Name:KENT
Middle Name:CHRISTOPHER
Last Name:HARRIS
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:592 SUNSET DR
Mailing Address - Street 2:
Mailing Address - City:ALTADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91001-1446
Mailing Address - Country:US
Mailing Address - Phone:626-445-2440
Mailing Address - Fax:626-445-2440
Practice Address - Street 1:1194 E WALNUT ST
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91106-1845
Practice Address - Country:US
Practice Address - Phone:626-580-4335
Practice Address - Fax:626-445-2440
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-29
Last Update Date:2008-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY18137103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACP18137Medicare UPIN