Provider Demographics
NPI:1205854320
Name:HARRIS, ANTHONY E (LPC)
Entity Type:Individual
Prefix:MR
First Name:ANTHONY
Middle Name:E
Last Name:HARRIS
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:541 BOGEY LN
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MO
Mailing Address - Zip Code:63755-3266
Mailing Address - Country:US
Mailing Address - Phone:573-243-1374
Mailing Address - Fax:
Practice Address - Street 1:619 N BROADVIEW ST
Practice Address - Street 2:
Practice Address - City:CAPE GIRARDEAU
Practice Address - State:MO
Practice Address - Zip Code:63701-4313
Practice Address - Country:US
Practice Address - Phone:573-334-3486
Practice Address - Fax:573-334-3524
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO002744101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO189490OtherBLUE CROSS BLUE SHIELD
448322OtherHEALTHLINK