Basic Information
| Provider Information | |||||||||
| NPI: | 1942458666 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HARPER | ||||||||
| FirstName: | EDWARD | ||||||||
| MiddleName: | L | ||||||||
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| Credential: | LCSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 5629 | ||||||||
| Address2: | |||||||||
| City: | MARYVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 378025629 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8652731752 | ||||||||
| FaxNumber: | 8652731755 | ||||||||
| Practice Location | |||||||||
| Address1: | 451 BMH PHYSICIANS OFFICE BLDG | ||||||||
| Address2: | |||||||||
| City: | MARYVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 378045807 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8659812315 | ||||||||
| FaxNumber: | 8659812302 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/06/2008 | ||||||||
| LastUpdateDate: | 11/14/2008 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | LDC0000000185 | TN | N | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) | 1041C0700X | LSW0000000734 | TN | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.