=====================================================
General NPI Number Information
=====================================================
NPI Number | 1356531446
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | RICHARD HERBERT HARRISON M.S., MFT, M.DIV.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/26/2007
-----------------------------------------------------
Last Update Date | 08/26/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3663 E SUNSET RD
-----------------------------------------------------
City | LAS VEGAS
-----------------------------------------------------
State | NV
-----------------------------------------------------
Zip | 89120-3218
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 702-794-0727
-----------------------------------------------------
Fax | 702-794-4501
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3663 E SUNSET RD
-----------------------------------------------------
City | LAS VEGAS
-----------------------------------------------------
State | NV
-----------------------------------------------------
Zip | 89120-3218
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 702-794-0727
-----------------------------------------------------
Fax | 702-794-4501
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 106H00000X
-----------------------------------------------------
Taxonomy Name | Marriage & Family Therapist
-----------------------------------------------------
License Number | 0612
-----------------------------------------------------
License Number State | NV
-----------------------------------------------------