Provider Demographics
NPI:1417006453
Name:HARRIS, BETTY (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:BETTY
Middle Name:
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 1:1913 BAYWOOD DR
Mailing Address - Street 2:
Mailing Address - City:ROCKPORT
Mailing Address - State:TX
Mailing Address - Zip Code:78382-3503
Mailing Address - Country:US
Mailing Address - Phone:512-577-6309
Mailing Address - Fax:
Practice Address - Street 1:13706 RESEARCH BLVD
Practice Address - Street 2:#211
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78750-1882
Practice Address - Country:US
Practice Address - Phone:512-577-6309
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-09
Last Update Date:2012-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX36389101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health