Provider Demographics
NPI:1467799783
Name:OPAL HARRIS
Entity Type:Organization
Organization Name:OPAL HARRIS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BHRS
Authorized Official - Prefix:MS
Authorized Official - First Name:OPAL
Authorized Official - Middle Name:
Authorized Official - Last Name:HARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-838-6340
Mailing Address - Street 1:7869 NE 10TH ST APT 195
Mailing Address - Street 2:
Mailing Address - City:MIDWEST CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73110-3674
Mailing Address - Country:US
Mailing Address - Phone:405-838-6340
Mailing Address - Fax:
Practice Address - Street 1:7869 NE 10TH ST APT 195
Practice Address - Street 2:
Practice Address - City:MIDWEST CITY
Practice Address - State:OK
Practice Address - Zip Code:73110-3674
Practice Address - Country:US
Practice Address - Phone:405-838-6340
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-07
Last Update Date:2013-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health