Provider Demographics
NPI:1992075386
Name:HARRIS, DANIELLE SELVIN (PSYD)
Entity type:Individual
Prefix:DR
First Name:DANIELLE
Middle Name:SELVIN
Last Name:HARRIS
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:DANIELLE
Other - Middle Name:LORI
Other - Last Name:SELVIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3625 E THOUSAND OAKS BLVD STE 106
Mailing Address - Street 2:
Mailing Address - City:WESTLAKE VILLAGE
Mailing Address - State:CA
Mailing Address - Zip Code:91362-3551
Mailing Address - Country:US
Mailing Address - Phone:310-461-4150
Mailing Address - Fax:
Practice Address - Street 1:3625 E THOUSAND OAKS BLVD STE 209
Practice Address - Street 2:
Practice Address - City:WESTLAKE VILLAGE
Practice Address - State:CA
Practice Address - Zip Code:91362-3566
Practice Address - Country:US
Practice Address - Phone:310-461-4150
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-03
Last Update Date:2022-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106H00000X
CA29884103T00000X
CA77169106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist