Healthcare Provider Details

I. General information

NPI: 1477484558
Provider Name (Legal Business Name): JASON ANTOINE HARRIS LMHC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/27/2026
Last Update Date: 05/27/2026
Certification Date: 05/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

633 UMATILLA BLVD
UMATILLA FL
32784-8418
US

IV. Provider business mailing address

PO BOX 531041
ATLANTA GA
30353-1041
US

V. Phone/Fax

Practice location:
  • Phone: 352-771-2700
  • Fax: 888-472-0401
Mailing address:
  • Phone: 352-771-2700
  • Fax: 888-472-0401

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH21955
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: