Healthcare Provider Details

I. General information

NPI: 1235465485
Provider Name (Legal Business Name): BEVERLY JANE HARRIS R.N., LPCI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/22/2009
Last Update Date: 10/22/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8035 E R L THORNTON FWY SUITE #503
DALLAS TX
75228-7018
US

IV. Provider business mailing address

18829 TUPELO LN
DALLAS TX
75287-2024
US

V. Phone/Fax

Practice location:
  • Phone: 214-319-9200
  • Fax:
Mailing address:
  • Phone: 972-765-0273
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number65188
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number517897
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: