Healthcare Provider Details

I. General information

NPI: 1114463353
Provider Name (Legal Business Name): CHRISTOPHER HARRIS PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/11/2017
Last Update Date: 11/17/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7429 SHALLOWFORD RD
CHATTANOOGA TN
37421-2629
US

IV. Provider business mailing address

7429 SHALLOWFORD RD
CHATTANOOGA TN
37421-2629
US

V. Phone/Fax

Practice location:
  • Phone: 423-308-2560
  • Fax:
Mailing address:
  • Phone: 615-512-6585
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number3649
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: