Healthcare Provider Details

I. General information

NPI: 1659668481
Provider Name (Legal Business Name): WILLIAM HARRIS CI
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2011
Last Update Date: 06/30/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1705 N. FM. 179
LUBBOCK TX
79416
US

IV. Provider business mailing address

2345 50TH STREET MANAGED CARE CENTER FOR ADDICTIVE/OTHER DISORDERS, INC.
LUBBOCK TX
79412
US

V. Phone/Fax

Practice location:
  • Phone: 806-797-8003
  • Fax: 806-797-7916
Mailing address:
  • Phone: 806-780-8300
  • Fax: 806-780-8383

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: