Provider Demographics
NPI:1467561381
Name:HARRIS, RODNEY C (LCSW)
Entity Type:Individual
Prefix:MR
First Name:RODNEY
Middle Name:C
Last Name:HARRIS
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1313 W ASH AVE STE 109
Mailing Address - Street 2:
Mailing Address - City:DUNCAN
Mailing Address - State:OK
Mailing Address - Zip Code:73533-4357
Mailing Address - Country:US
Mailing Address - Phone:580-475-0519
Mailing Address - Fax:580-475-0689
Practice Address - Street 1:1313 W ASH AVE STE 109
Practice Address - Street 2:
Practice Address - City:DUNCAN
Practice Address - State:OK
Practice Address - Zip Code:73533-4357
Practice Address - Country:US
Practice Address - Phone:580-475-0519
Practice Address - Fax:580-475-0689
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2023-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC004224101YA0400X, 102L00000X, 106H00000X, 1041C0700X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No102L00000XBehavioral Health & Social Service ProvidersPsychoanalyst
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6106134Medicaid