Provider Demographics
NPI:1083491385
Name:HARRIS, JALYN CHAUNTESE (ALC)
Entity Type:Individual
Prefix:
First Name:JALYN
Middle Name:CHAUNTESE
Last Name:HARRIS
Suffix:
Gender:F
Credentials:ALC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:524 HUFFMAN RD
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35215-8300
Mailing Address - Country:US
Mailing Address - Phone:205-994-4563
Mailing Address - Fax:205-206-7131
Practice Address - Street 1:524 HUFFMAN RD
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35215-8300
Practice Address - Country:US
Practice Address - Phone:205-994-4563
Practice Address - Fax:205-206-7131
Is Sole Proprietor?:No
Enumeration Date:2023-09-11
Last Update Date:2023-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALALC04505101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor