Healthcare Provider Details

I. General information

NPI: 1700559549
Provider Name (Legal Business Name): KOURTNEY HARRIS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/28/2021
Last Update Date: 05/08/2026
Certification Date: 05/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

706 JOHNSON AVE
BEDFORD OH
44146-3728
US

IV. Provider business mailing address

706 JOHNSON AVE
BEDFORD OH
44146-3728
US

V. Phone/Fax

Practice location:
  • Phone: 216-210-5905
  • Fax:
Mailing address:
  • Phone: 216-210-5905
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberE.2606642
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: