Provider Demographics
NPI:1346652013
Name:HARRIS, GLENN TRUMAN (BA)
Entity Type:Individual
Prefix:
First Name:GLENN
Middle Name:TRUMAN
Last Name:HARRIS
Suffix:
Gender:M
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 ALPINE DR
Mailing Address - Street 2:
Mailing Address - City:SHELBYVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40065-8880
Mailing Address - Country:US
Mailing Address - Phone:502-633-5683
Mailing Address - Fax:
Practice Address - Street 1:250 ALPINE DR
Practice Address - Street 2:
Practice Address - City:SHELBYVILLE
Practice Address - State:KY
Practice Address - Zip Code:40065-8880
Practice Address - Country:US
Practice Address - Phone:502-633-5683
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-28
Last Update Date:2014-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No251S00000XAgenciesCommunity/Behavioral Health