Basic Information
| Provider Information | |||||||||
| NPI: | 1982969333 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HARRIS | ||||||||
| FirstName: | DEREK | ||||||||
| MiddleName: | |||||||||
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| Credential: | CAC II | ||||||||
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| Mailing Information | |||||||||
| Address1: | 211 W MAIN ST | ||||||||
| Address2: | |||||||||
| City: | STERLING | ||||||||
| State: | CO | ||||||||
| PostalCode: | 807513168 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9705224549 | ||||||||
| FaxNumber: | 9705224211 | ||||||||
| Practice Location | |||||||||
| Address1: | 216 N 3RD ST | ||||||||
| Address2: | |||||||||
| City: | STERLING | ||||||||
| State: | CO | ||||||||
| PostalCode: | 807514302 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9705266577 | ||||||||
| FaxNumber: | 9709650059 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/11/2012 | ||||||||
| LastUpdateDate: | 05/15/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 05/15/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | ACB-7361 | CO | Y | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) |
No ID Information.