Provider Demographics
NPI:1467724294
Name:NORRIS, HARVEY
Entity Type:Individual
Prefix:
First Name:HARVEY
Middle Name:
Last Name:NORRIS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6606 MONROE HWY
Mailing Address - Street 2:
Mailing Address - City:BALL
Mailing Address - State:LA
Mailing Address - Zip Code:71405-3226
Mailing Address - Country:US
Mailing Address - Phone:850-508-8104
Mailing Address - Fax:866-399-5815
Practice Address - Street 1:2495 SHREVEPORT HWY
Practice Address - Street 2:BUILDING 3, ROOM 115, SERVICE 122
Practice Address - City:PINEVILLE
Practice Address - State:LA
Practice Address - Zip Code:71360-4044
Practice Address - Country:US
Practice Address - Phone:800-375-8387
Practice Address - Fax:866-399-5915
Is Sole Proprietor?:No
Enumeration Date:2012-02-09
Last Update Date:2013-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW81131041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical