Provider Demographics
NPI:1295402931
Name:HARRIS, JESSICA ROSE (MSW)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:ROSE
Last Name:HARRIS
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:294 E NORTH AVE
Mailing Address - Street 2:
Mailing Address - City:CRESTVIEW
Mailing Address - State:FL
Mailing Address - Zip Code:32536-2355
Mailing Address - Country:US
Mailing Address - Phone:850-774-1327
Mailing Address - Fax:
Practice Address - Street 1:160 DUGGAN AVE
Practice Address - Street 2:
Practice Address - City:CRESTVIEW
Practice Address - State:FL
Practice Address - Zip Code:32536-4812
Practice Address - Country:US
Practice Address - Phone:850-774-1327
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-29
Last Update Date:2021-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health