Provider Demographics
NPI:1023439031
Name:HARRIS, MARIAM (LMFT)
Entity type:Individual
Prefix:MRS
First Name:MARIAM
Middle Name:
Last Name:HARRIS
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 MAUCHLY STE 319
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92618-2361
Mailing Address - Country:US
Mailing Address - Phone:949-690-5393
Mailing Address - Fax:
Practice Address - Street 1:22362 GILBERTO STE 130
Practice Address - Street 2:RANCHO SANTA MARGARI, CA 92688
Practice Address - City:RANCHO SANTA MARGARITA
Practice Address - State:CA
Practice Address - Zip Code:92688-2142
Practice Address - Country:US
Practice Address - Phone:949-690-5393
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-17
Last Update Date:2013-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA78002106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist