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NPI Code Detail

MEDICARE: MS. KRISTY DAWN HARRIS MA, LPC

MEDICARE: MS. KRISTY DAWN HARRIS MA, 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
1101YM0800XMental Health CounselorPC004413PA

General Provider Information

NPI Number : 1487788568
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. KRISTY DAWN HARRIS MA, LPC
Provider Business Mailing Address
First Line : 6227 REVERE ST
Second Line :
City : PHILADELPHIA
State : PA
Zip : 19149-3024
Country : US
Telephone Number : 215-535-7718
Fax Number :
Provider Business Practice Location Address
First Line : 521 MOREDON RD
Second Line :
City : HUNTINGDON VALLEY
State : PA
Zip : 19006-7705
Country : US
Telephone Number : 215-914-4190
Fax Number : 215-914-4197
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/14/2007
Last Update Date : 07/08/2007

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