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NPI Code Detail

MEDICARE: SUSAN BETH HARRIS

MEDICARE: SUSAN BETH HARRIS
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103K00000XBehavior AnalystOK
2171M00000XCase Manager/Care Coordinator

General Provider Information

NPI Number : 1104258623
Entity Type Code : Individual
Provider Name (Legal Business Name) : SUSAN BETH HARRIS
Provider Business Mailing Address
First Line : 407 W SOUTH AVE
Second Line :
City : PONCA CITY
State : OK
Zip : 74601-6133
Country : US
Telephone Number : 844-458-2100
Fax Number :
Provider Business Practice Location Address
First Line : 407 W SOUTH AVE
Second Line :
City : PONCA CITY
State : OK
Zip : 74601-6133
Country : US
Telephone Number : 844-458-2100
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/07/2013
Last Update Date : 04/07/2023

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