Healthcare Provider Details

I. General information

NPI: 1265275226
Provider Name (Legal Business Name): HARRY EVERETT DMIN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/17/2024
Last Update Date: 06/17/2024
Certification Date: 06/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

163 TOWN PL
FAIRVIEW TX
75069-1821
US

IV. Provider business mailing address

PO BOX 733
ALLEN TX
75013-0012
US

V. Phone/Fax

Practice location:
  • Phone: 214-450-0115
  • Fax:
Mailing address:
  • Phone: 214-450-0115
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP1600X
TaxonomyPastoral Counselor
License Number
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: