Provider Demographics
NPI:1811171812
Name:HARRIS, MICHELLE BROOKE (MA)
Entity type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:BROOKE
Last Name:HARRIS
Suffix:
Gender:F
Credentials:MA
Other - Prefix:MS
Other - First Name:MICHELLE
Other - Middle Name:BROOKE
Other - Last Name:NEITHINGER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FRANKS
Mailing Address - Street 1:4370 TOWN CENTER BLVD STE 300
Mailing Address - Street 2:
Mailing Address - City:EL DORADO HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:95762-7140
Mailing Address - Country:US
Mailing Address - Phone:916-337-8777
Mailing Address - Fax:916-649-7158
Practice Address - Street 1:4370 TOWN CENTER BLVD STE 300
Practice Address - Street 2:
Practice Address - City:EL DORADO HILLS
Practice Address - State:CA
Practice Address - Zip Code:95762-7140
Practice Address - Country:US
Practice Address - Phone:916-337-8777
Practice Address - Fax:916-649-7158
Is Sole Proprietor?:No
Enumeration Date:2007-12-27
Last Update Date:2024-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC53424106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist