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General NPI Number Information
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NPI Number | 1700695335
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Entity Type | Individual
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Provider Name | MRS. DEJAH M HARRIS
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Gender | Female
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Dates
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Enumeration Date | 01/07/2025
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Last Update Date | 01/07/2025
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Provider Practice Location Address
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Address Line | 500 N HAYS RD
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City | CLYDE
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State | TX
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Zip | 79510-5500
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Country | US
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Telephone | 325-893-2161
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Fax |
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Provider Business Mailing Address
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Address Line | 301 CORNERSTONE CT
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City | ABILENE
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State | TX
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Zip | 79602-1057
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Country | US
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Telephone | 325-660-6587
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number |
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License Number State |
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