Provider Demographics
NPI:1851478366
Name:HARRIS, SANDRA ANN (LMHC)
Entity type:Individual
Prefix:MRS
First Name:SANDRA
Middle Name:ANN
Last Name:HARRIS
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:MRS
Other - First Name:SANDRA
Other - Middle Name:ANN
Other - Last Name:KLETTKE-HARRIS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LMHC
Mailing Address - Street 1:545 RAINIER BLVD N
Mailing Address - Street 2:STE # 4
Mailing Address - City:ISSAQUAH
Mailing Address - State:WA
Mailing Address - Zip Code:98027-2806
Mailing Address - Country:US
Mailing Address - Phone:425-392-3364
Mailing Address - Fax:425-392-5587
Practice Address - Street 1:545 RAINIER BLVD N
Practice Address - Street 2:STE # 4
Practice Address - City:ISSAQUAH
Practice Address - State:WA
Practice Address - Zip Code:98027-2806
Practice Address - Country:US
Practice Address - Phone:425-392-3364
Practice Address - Fax:425-392-5587
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH00003770101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health