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General NPI Number Information
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NPI Number | 1497736458
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Entity Type | Individual
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Provider Name | STEPHEN ROBERT HARRIS PHD
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Gender | Male
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Dates
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Enumeration Date | 11/08/2005
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Last Update Date | 05/24/2010
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Provider Practice Location Address
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Address Line | 715 W SHERMAN AVE STE F
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City | HARRISON
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State | AR
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Zip | 72601-2743
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Country | US
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Telephone | 870-577-2830
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Fax | 870-741-3457
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Provider Business Mailing Address
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Address Line | 128 SAINT ANDREWS CIR
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City | HIDEAWAY
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State | TX
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Zip | 75771-5056
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Country | US
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Telephone |
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Fax | 870-741-3457
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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 | 19-76P
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License Number State | AR
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