Healthcare Provider Details

I. General information

NPI: 1154498509
Provider Name (Legal Business Name): SHAY L HARRIS MSW, LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/29/2006
Last Update Date: 05/14/2020
Certification Date: 05/14/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17840 CUMBERLAND RD
NOBLESVILLE IN
46060-5409
US

IV. Provider business mailing address

17840 CUMBERLAND RD
NOBLESVILLE IN
46060-5409
US

V. Phone/Fax

Practice location:
  • Phone: 317-371-0329
  • Fax:
Mailing address:
  • Phone: 317-371-0329
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number34008803A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number2389123
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: