Healthcare Provider Details

I. General information

NPI: 1588482798
Provider Name (Legal Business Name): BRIAN JEFFERY HARRIS LMSW, LMAC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/27/2024
Last Update Date: 09/27/2024
Certification Date: 09/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 SW 39TH ST
TOPEKA KS
66609-1360
US

IV. Provider business mailing address

900 SW 39TH ST
TOPEKA KS
66609-1360
US

V. Phone/Fax

Practice location:
  • Phone: 785-213-9076
  • Fax: 785-833-2040
Mailing address:
  • Phone: 785-213-9076
  • Fax: 785-833-2040

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number00966
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number11911
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: