Provider Demographics
NPI:1184108805
Name:HARRIS, KAYLIE LYNNE
Entity type:Individual
Prefix:
First Name:KAYLIE
Middle Name:LYNNE
Last Name:HARRIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3891 BLACKWOOD ST
Mailing Address - Street 2:
Mailing Address - City:NEWBURY PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91320-4901
Mailing Address - Country:US
Mailing Address - Phone:530-556-5613
Mailing Address - Fax:
Practice Address - Street 1:1901 ROYAL OAKS DR STE 201
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95815-4235
Practice Address - Country:US
Practice Address - Phone:916-923-1789
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-19
Last Update Date:2025-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician