Healthcare Provider Details

I. General information

NPI: 1689731663
Provider Name (Legal Business Name): ALAN JAY HARRIS PHD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/02/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3716 UNIVERSITY BLVD SOUTH STE 6
JACKSONVILLE FL
32216
US

IV. Provider business mailing address

3716 UNIVERSITY BLVD SOUTH STE 6
JACKSONVILLE FL
32216
US

V. Phone/Fax

Practice location:
  • Phone: 904-739-3688
  • Fax: 907-367-0250
Mailing address:
  • Phone: 904-739-3688
  • Fax: 907-367-0250

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPY0003387
License Number StateFL

VIII. Authorized Official

Name: DR. ALAN J HARRIS
Title or Position: PRESIDENT
Credential: PHD
Phone: 904-739-3688