Provider Demographics
NPI:1407062318
Name:HARBER, JERRY LANCE (MFT, LPC-MHSP)
Entity Type:Individual
Prefix:MR
First Name:JERRY
Middle Name:LANCE
Last Name:HARBER
Suffix:
Gender:M
Credentials:MFT, LPC-MHSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:160 S HOLMES ST
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38111-4521
Mailing Address - Country:US
Mailing Address - Phone:901-409-5474
Mailing Address - Fax:
Practice Address - Street 1:160 S HOLMES ST
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38111-4521
Practice Address - Country:US
Practice Address - Phone:901-409-5474
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNLPC TN005101YM0800X
TNTN MFT002106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN005OtherLPC LICENSE
TN002OtherMFT LICENSE