MEDICARE: DR. TYNDALL PEACOCK HARRIS PH.D., 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
1	101YP2500X	Professional Counselor	6782	NC

General Provider Information

NPI Number	:	1932340833
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TYNDALL PEACOCK HARRIS PH.D., LPC

Provider Business Mailing Address
First Line	:	PO BOX 447
Second Line	:
City	:	CARRBORO
State	:	NC
Zip	:	27510-0447
Country	:	US
Telephone Number	:	919-933-3710
Fax Number	:

Provider Business Practice Location Address
First Line	:	307 N COLUMBIA ST
Second Line	:
City	:	CHAPEL HILL
State	:	NC
Zip	:	27516-2119
Country	:	US
Telephone Number	:	919-933-3710
Fax Number	:

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

Provider Enumeration Date	:	03/23/2009
Last Update Date	:	03/23/2009

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