Provider Demographics
NPI:1356498125
Name:HARRISON, KIT W (PHD)
Entity Type:Individual
Prefix:DR
First Name:KIT
Middle Name:W
Last Name:HARRISON
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:510 BERING DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77057-1457
Mailing Address - Country:US
Mailing Address - Phone:713-961-1112
Mailing Address - Fax:713-961-5202
Practice Address - Street 1:510 BERING DR
Practice Address - Street 2:SUITE 200
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77057-1457
Practice Address - Country:US
Practice Address - Phone:713-961-1112
Practice Address - Fax:713-961-5202
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX22652103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0976946-01Medicaid
TX00BY31Medicare ID - Type Unspecified