Healthcare Provider Details

I. General information

NPI: 1265164347
Provider Name (Legal Business Name): JEFF EUGENE HARRIS PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/28/2022
Last Update Date: 06/28/2022
Certification Date: 06/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2326 LA SENDA DR
LAS CRUCES NM
88011-9179
US

IV. Provider business mailing address

2326 LA SENDA DR
LAS CRUCES NM
88011-9179
US

V. Phone/Fax

Practice location:
  • Phone: 940-435-8858
  • Fax:
Mailing address:
  • Phone: 940-435-8858
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPSY1539
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: