Healthcare Provider Details

I. General information

NPI: 1811293699
Provider Name (Legal Business Name): DEBORAH J HARRIS L.P.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: DEBBIE HARRIS L.P.C.

II. Dates (important events)

Enumeration Date: 01/27/2011
Last Update Date: 07/31/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

820 STATELINE RD STE B
COLCORD OK
74338-1348
US

IV. Provider business mailing address

820 STATELINE RD STE B
COLCORD OK
74338-1348
US

V. Phone/Fax

Practice location:
  • Phone: 479-524-0477
  • Fax:
Mailing address:
  • Phone: 479-524-0477
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberP0406024
License Number StateAR
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberP0406024
License Number StateAR
# 3
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberP0406024
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: