Provider Demographics
NPI:1053011320
Name:HARRIS, LYNNETTE M (MA, AMFT)
Entity type:Individual
Prefix:
First Name:LYNNETTE
Middle Name:M
Last Name:HARRIS
Suffix:
Gender:F
Credentials:MA, AMFT
Other - Prefix:
Other - First Name:LYNNETTE
Other - Middle Name:M
Other - Last Name:SNARR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 188022
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95818-8022
Mailing Address - Country:US
Mailing Address - Phone:916-678-1141
Mailing Address - Fax:
Practice Address - Street 1:1925 WINCHESTER BLVD
Practice Address - Street 2:
Practice Address - City:CAMPBELL
Practice Address - State:CA
Practice Address - Zip Code:95008-1037
Practice Address - Country:US
Practice Address - Phone:408-508-3611
Practice Address - Fax:408-663-5504
Is Sole Proprietor?:No
Enumeration Date:2023-03-06
Last Update Date:2023-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA137105106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist