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NPI Code Detail

MEDICARE: DEIDRA HARBOUR LPC

MEDICARE: DEIDRA HARBOUR LPC
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
1101YP2500XProfessional Counselor13386TX

General Provider Information

NPI Number : 1194342741
Entity Type Code : Individual
Provider Name (Legal Business Name) : DEIDRA HARBOUR LPC
Provider Business Mailing Address
First Line : 3511 PEARL ST
Second Line :
City : NACOGDOCHES
State : TX
Zip : 75965-2457
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 3824 N UNIVERSITY DR
Second Line :
City : NACOGDOCHES
State : TX
Zip : 75965-2011
Country : US
Telephone Number : 936-558-6202
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/30/2020
Last Update Date : 06/30/2020

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Directions to “ DEIDRA HARBOUR LPC” Practice Location

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