Provider Demographics
NPI:1457311847
Name:HARRIS, RENEE LEE (MS)
Entity Type:Individual
Prefix:MS
First Name:RENEE
Middle Name:LEE
Last Name:HARRIS
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:278 N HIGH ST
Mailing Address - Street 2:PO BOX 1830
Mailing Address - City:ROMNEY
Mailing Address - State:WV
Mailing Address - Zip Code:26757-1415
Mailing Address - Country:US
Mailing Address - Phone:304-822-3429
Mailing Address - Fax:304-822-7225
Practice Address - Street 1:278 N HIGH ST
Practice Address - Street 2:SUITE 1
Practice Address - City:ROMNEY
Practice Address - State:WV
Practice Address - Zip Code:26757-1415
Practice Address - Country:US
Practice Address - Phone:304-822-3429
Practice Address - Fax:304-822-7225
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-28
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV794103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV9202193000Medicaid