Healthcare Provider Details

I. General information

NPI: 1568635407
Provider Name (Legal Business Name): HARLAND CLAY HARRIS LPC/MHSP SUPERVISOR
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/11/2008
Last Update Date: 12/12/2024
Certification Date: 12/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3441 MILFORD DR
THOMPSONS STATION TN
37179-1523
US

IV. Provider business mailing address

3441 MILFORD DR
THOMPSONS STATION TN
37179-1523
US

V. Phone/Fax

Practice location:
  • Phone: 615-766-0218
  • Fax:
Mailing address:
  • Phone: 615-766-0218
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number61480
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number61480
License Number StateTX
# 3
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2565
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: