MEDICARE: BETSY HARRIS LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	104100000X	Social Worker	LSW0000008629	TN
2	1041C0700X	Clinical Social Worker	6253	TN

General Provider Information

NPI Number	:	1225386832
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BETSY HARRIS LCSW

Provider Business Mailing Address
First Line	:	1324 TROTWOOD AVE STE 6
Second Line	:
City	:	COLUMBIA
State	:	TN
Zip	:	38401-4750
Country	:	US
Telephone Number	:	931-954-2853
Fax Number	:	931-321-2006

Provider Business Practice Location Address
First Line	:	1324 TROTWOOD AVE STE 6
Second Line	:
City	:	COLUMBIA
State	:	TN
Zip	:	38401-4750
Country	:	US
Telephone Number	:	931-954-2853
Fax Number	:	931-321-2006

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/29/2012
Last Update Date	:	11/10/2020

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