Provider Demographics
NPI:1285846139
Name:HARRIS, JAMI DANIELLE (LCSW)
Entity Type:Individual
Prefix:
First Name:JAMI
Middle Name:DANIELLE
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 1:3095 W LOST RAPIDS DR
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83642-6199
Mailing Address - Country:US
Mailing Address - Phone:208-884-3953
Mailing Address - Fax:
Practice Address - Street 1:10740 W FAIRVIEW AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83713-7926
Practice Address - Country:US
Practice Address - Phone:208-376-0191
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLCSW-276541041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical