Basic Information
| Provider Information | |||||||||
| NPI: | 1972725562 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HARRIS | ||||||||
| FirstName: | PENNY | ||||||||
| MiddleName: | E | ||||||||
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| Credential: | M.ED., CAC, LPC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3030 CHESTNUT STREET | ||||||||
| Address2: | |||||||||
| City: | LEBANON | ||||||||
| State: | PA | ||||||||
| PostalCode: | 17042 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7172738000 | ||||||||
| FaxNumber: | 7172738244 | ||||||||
| Practice Location | |||||||||
| Address1: | 3030 CHESTNUT STREET | ||||||||
| Address2: | |||||||||
| City: | LEBANON | ||||||||
| State: | PA | ||||||||
| PostalCode: | 17042 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7172738000 | ||||||||
| FaxNumber: | 7172738244 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/03/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | X | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) | 101YP2500X | PC001737 | PA | X | Behavioral Health & Social Service Providers | Counselor | Professional |
No ID Information.