Provider Demographics
NPI:1548714314
Name:HARRIS, BRANDON (LMHC)
Entity type:Individual
Prefix:
First Name:BRANDON
Middle Name:
Last Name:HARRIS
Suffix:
Gender:M
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5560 PACIFIC BLVD
Mailing Address - Street 2:409
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33433-6739
Mailing Address - Country:US
Mailing Address - Phone:954-552-9773
Mailing Address - Fax:
Practice Address - Street 1:5560 PACIFIC BLVD
Practice Address - Street 2:409
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33433-6739
Practice Address - Country:US
Practice Address - Phone:954-552-9773
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-10
Last Update Date:2016-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH11597101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health