Provider Demographics
NPI:1275252553
Name:HARRIS, CHRISTOPHER ALLEN-MICHAEL (TCADC)
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:ALLEN-MICHAEL
Last Name:HARRIS
Suffix:
Gender:M
Credentials:TCADC
Other - Prefix:
Other - First Name:CHRIS
Other - Middle Name:
Other - Last Name:HARRIS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:TCADC
Mailing Address - Street 1:821 W 12TH AVE N APT 12
Mailing Address - Street 2:
Mailing Address - City:CLEAR LAKE
Mailing Address - State:IA
Mailing Address - Zip Code:50428-1189
Mailing Address - Country:US
Mailing Address - Phone:641-529-7841
Mailing Address - Fax:
Practice Address - Street 1:138 N CLARK ST
Practice Address - Street 2:
Practice Address - City:FOREST CITY
Practice Address - State:IA
Practice Address - Zip Code:50436-1643
Practice Address - Country:US
Practice Address - Phone:641-585-2060
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-22
Last Update Date:2022-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAT22141101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)