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General NPI Number Information
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NPI Number | 1285387993
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Entity Type | Individual
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Provider Name | NATHAN MICHAEL HARRIMAN
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Gender | Male
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Dates
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Enumeration Date | 02/02/2022
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Last Update Date | 02/02/2022
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Provider Practice Location Address
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Address Line | 3680 N INVESTMENT DR STE 1
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City | FAYETTEVILLE
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State | AR
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Zip | 72703-5458
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Country | US
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Telephone | 479-435-9356
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Fax |
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Provider Business Mailing Address
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Address Line | 1061 N PEMBROKE RD
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City | FAYETTEVILLE
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State | AR
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Zip | 72701-2524
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | A2011160
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License Number State | AR
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