Provider Demographics
NPI:1053201095
Name:HARRIS, ELECTRA LUCETTE (LADC, MENTAL HEALTH)
Entity type:Individual
Prefix:MRS
First Name:ELECTRA
Middle Name:LUCETTE
Last Name:HARRIS
Suffix:
Gender:F
Credentials:LADC, MENTAL HEALTH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10941 DOUGLAS LN N
Mailing Address - Street 2:
Mailing Address - City:CHAMPLIN
Mailing Address - State:MN
Mailing Address - Zip Code:55316-3563
Mailing Address - Country:US
Mailing Address - Phone:763-777-1471
Mailing Address - Fax:763-777-1471
Practice Address - Street 1:10941 DOUGLAS LN N
Practice Address - Street 2:
Practice Address - City:CHAMPLIN
Practice Address - State:MN
Practice Address - Zip Code:55316-3563
Practice Address - Country:US
Practice Address - Phone:763-777-1471
Practice Address - Fax:763-777-1471
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-09
Last Update Date:2025-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health