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General NPI Number Information
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NPI Number | 1194342741
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Entity Type | Individual
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Provider Name | DEIDRA HARBOUR LPC
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Gender | Female
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Dates
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Enumeration Date | 06/30/2020
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Last Update Date | 06/30/2020
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Provider Practice Location Address
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Address Line | 3824 N UNIVERSITY DR
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City | NACOGDOCHES
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State | TX
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Zip | 75965-2011
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Country | US
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Telephone | 936-558-6202
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Fax |
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Provider Business Mailing Address
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Address Line | 3511 PEARL ST
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City | NACOGDOCHES
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State | TX
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Zip | 75965-2457
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 13386
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License Number State | TX
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