Basic Information
| Provider Information | |||||||||
| NPI: | 1851877849 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HARRIS | ||||||||
| FirstName: | DAVID | ||||||||
| MiddleName: | R | ||||||||
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| Credential: | LPC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 11818 | ||||||||
| Address2: | |||||||||
| City: | FORT SMITH | ||||||||
| State: | AR | ||||||||
| PostalCode: | 729171818 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4794526650 | ||||||||
| FaxNumber: | 4794525847 | ||||||||
| Practice Location | |||||||||
| Address1: | 3111 S 70TH ST | ||||||||
| Address2: | |||||||||
| City: | FORT SMITH | ||||||||
| State: | AR | ||||||||
| PostalCode: | 729035017 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4794526650 | ||||||||
| FaxNumber: | 4794525847 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/13/2018 | ||||||||
| LastUpdateDate: | 05/05/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 05/05/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | A1809134 | AR | N | Behavioral Health & Social Service Providers | Counselor | Mental Health | 171M00000X | AR | N | Other Service Providers | Case Manager/Care Coordinator | 101YP2500X | P2010083 | AR | Y | Behavioral Health & Social Service Providers | Counselor | Professional |
No ID Information.