Provider Demographics
NPI:1083805337
Name:HARRIS, JENNIFER WALKER (MS)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:WALKER
Last Name:HARRIS
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:WALKER
Other - Last Name:PERKINS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS
Mailing Address - Street 1:PO BOX 320792
Mailing Address - Street 2:
Mailing Address - City:FLOWOOD
Mailing Address - State:MS
Mailing Address - Zip Code:39232-0792
Mailing Address - Country:US
Mailing Address - Phone:016-790-0205
Mailing Address - Fax:
Practice Address - Street 1:1635 LELIA DR STE 100
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39216-4876
Practice Address - Country:US
Practice Address - Phone:601-790-0205
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-01
Last Update Date:2023-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSN/A101YM0800X
MS1305101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health