Provider Demographics
NPI:1033568506
Name:HARRIS, CHEYENNE (LADC-MH)
Entity Type:Individual
Prefix:
First Name:CHEYENNE
Middle Name:
Last Name:HARRIS
Suffix:
Gender:F
Credentials:LADC-MH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2020 TIMBERVIEW DR
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73013-2736
Mailing Address - Country:US
Mailing Address - Phone:405-977-7238
Mailing Address - Fax:
Practice Address - Street 1:525 LIBERTY LN
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73034-9046
Practice Address - Country:US
Practice Address - Phone:405-977-7238
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-06
Last Update Date:2021-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1325101YM0800X
171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No171M00000XOther Service ProvidersCase Manager/Care Coordinator