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General NPI Number Information
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NPI Number | 1346461423
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Entity Type | Individual
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Provider Name | CHARLES EUGENE HARRIS PH.D.
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Gender | Male
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Dates
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Enumeration Date | 05/02/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 5427-A GEX RD
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City | DIAMONDHEAD
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State | MS
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Zip | 39525
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Country | US
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Telephone | 228-255-4832
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Fax |
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Provider Business Mailing Address
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Address Line | 1217 NELSON DR
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City | OCEAN SPRINGS
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State | MS
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Zip | 39564-3032
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Country | US
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Telephone | 228-875-7648
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Fax | 228-872-9493
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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 | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 36-620
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License Number State | MS
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