Provider Demographics
NPI:1750612933
Name:HARRIS, THERESA L (LCSW)
Entity type:Individual
Prefix:MRS
First Name:THERESA
Middle Name:L
Last Name:HARRIS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:TERRY
Other - Middle Name:
Other - Last Name:HARRIS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:855 CANYON RD
Mailing Address - Street 2:
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96001-5544
Mailing Address - Country:US
Mailing Address - Phone:530-223-2822
Mailing Address - Fax:530-223-1917
Practice Address - Street 1:855 CANYON RD
Practice Address - Street 2:
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96001-5544
Practice Address - Country:US
Practice Address - Phone:530-223-2822
Practice Address - Fax:530-223-1917
Is Sole Proprietor?:No
Enumeration Date:2010-01-27
Last Update Date:2021-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAASW 695701041C0700X
CA1019881041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical