Provider Demographics
NPI:1245776178
Name:HARRIS, JESSICA (LPCA)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:HARRIS
Suffix:
Gender:F
Credentials:LPCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6860 ANTON RD
Mailing Address - Street 2:
Mailing Address - City:MADISONVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42431-8542
Mailing Address - Country:US
Mailing Address - Phone:270-841-0785
Mailing Address - Fax:
Practice Address - Street 1:230 2ND ST
Practice Address - Street 2:SUITE 308
Practice Address - City:HENDERSON
Practice Address - State:KY
Practice Address - Zip Code:42420-3172
Practice Address - Country:US
Practice Address - Phone:270-826-8761
Practice Address - Fax:270-826-8737
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-17
Last Update Date:2017-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY128141101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health