Provider Demographics
NPI:1225386832
Name:HARRIS, BETSY (LCSW)
Entity Type:Individual
Prefix:
First Name:BETSY
Middle Name:
Last Name:HARRIS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1324 TROTWOOD AVE STE 6
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:TN
Mailing Address - Zip Code:38401-4750
Mailing Address - Country:US
Mailing Address - Phone:931-954-2853
Mailing Address - Fax:931-321-2006
Practice Address - Street 1:1324 TROTWOOD AVE STE 6
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:TN
Practice Address - Zip Code:38401-4750
Practice Address - Country:US
Practice Address - Phone:931-954-2853
Practice Address - Fax:931-321-2006
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-29
Last Update Date:2020-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNLSW0000008629104100000X
TN62531041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker