Healthcare Provider Details

I. General information

NPI: 1497736458
Provider Name (Legal Business Name): STEPHEN ROBERT HARRIS PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/08/2005
Last Update Date: 05/24/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

715 W SHERMAN AVE STE F
HARRISON AR
72601-2743
US

IV. Provider business mailing address

128 SAINT ANDREWS CIR
HIDEAWAY TX
75771-5056
US

V. Phone/Fax

Practice location:
  • Phone: 870-577-2830
  • Fax: 870-741-3457
Mailing address:
  • Phone:
  • Fax: 870-741-3457

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number19-76P
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: