Healthcare Provider Details

I. General information

NPI: 1952292260
Provider Name (Legal Business Name): SCOTTIE TERRELL HARRIS SR. CADC-CAS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2025
Last Update Date: 07/15/2025
Certification Date: 07/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4468 E CESAR CHAVEZ BLVD
FRESNO CA
93702-3605
US

IV. Provider business mailing address

4468 E CESAR CHAVEZ BLVD
FRESNO CA
93702-3605
US

V. Phone/Fax

Practice location:
  • Phone: 559-600-9180
  • Fax:
Mailing address:
  • Phone: 559-600-9180
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberC057190618
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: