MEDICARE: AUDRA SCOTT HARRISON 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	1041C0700X	Clinical Social Worker	3629	KY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1285717470
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AUDRA SCOTT HARRISON LCSW

Provider Business Mailing Address
First Line	:	PO BOX 614
Second Line	:
City	:	HOPKINSVILLE
State	:	KY
Zip	:	42241-0614
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	737B NORTH DR
Second Line	:
City	:	HOPKINSVILLE
State	:	KY
Zip	:	42240-2620
Country	:	US
Telephone Number	:	270-991-9551
Fax Number	:

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

Provider Enumeration Date	:	10/23/2006
Last Update Date	:	06/17/2024

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