MEDICARE: DEBORAH J HARRIS L.P.C.

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
1	101Y00000X	Counselor	P0406024	AR
2	101YM0800X	Mental Health Counselor	P0406024	AR
3	101YP2500X	Professional Counselor	P0406024	AR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1811293699
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DEBORAH J HARRIS L.P.C.

Provider Business Mailing Address
First Line	:	820 STATELINE RD STE B
Second Line	:
City	:	COLCORD
State	:	OK
Zip	:	74338-1348
Country	:	US
Telephone Number	:	479-524-0477
Fax Number	:

Provider Business Practice Location Address
First Line	:	820 STATELINE RD STE B
Second Line	:
City	:	COLCORD
State	:	OK
Zip	:	74338-1348
Country	:	US
Telephone Number	:	479-524-0477
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/27/2011
Last Update Date	:	07/31/2012

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