Provider Demographics
NPI:1285684159
Name:HARRIS, THERESA E (MSW, LCSW)
Entity Type:Individual
Prefix:
First Name:THERESA
Middle Name:E
Last Name:HARRIS
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:THERESA
Other - Middle Name:E
Other - Last Name:BLANKENSHIP-CORL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW,LCSW
Mailing Address - Street 1:8085 NW 151 RD
Mailing Address - Street 2:
Mailing Address - City:LOWRY CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64763-9165
Mailing Address - Country:US
Mailing Address - Phone:417-309-0207
Mailing Address - Fax:660-885-9116
Practice Address - Street 1:1835 S. 2ND STREET
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:MO
Practice Address - Zip Code:64735-9165
Practice Address - Country:US
Practice Address - Phone:660-885-9100
Practice Address - Fax:660-885-9116
Is Sole Proprietor?:No
Enumeration Date:2006-05-11
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2002012583104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker