Provider Demographics
NPI:1871734251
Name:HARRIS, BECHAEL SYANDENE (PMHNP)
Entity type:Individual
Prefix:
First Name:BECHAEL
Middle Name:SYANDENE
Last Name:HARRIS
Suffix:
Gender:
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:879 W 190TH ST STE 400
Mailing Address - Street 2:
Mailing Address - City:GARDENA
Mailing Address - State:CA
Mailing Address - Zip Code:90248-4223
Mailing Address - Country:US
Mailing Address - Phone:310-908-6753
Mailing Address - Fax:
Practice Address - Street 1:879 W 190TH ST STE 400
Practice Address - Street 2:
Practice Address - City:GARDENA
Practice Address - State:CA
Practice Address - Zip Code:90248-4223
Practice Address - Country:US
Practice Address - Phone:310-908-6753
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-03-16
Last Update Date:2025-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAVN181322164X00000X
CA95034584363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No164X00000XNursing Service ProvidersLicensed Vocational Nurse