Provider Demographics
NPI:1487822862
Name:HARRIS, BOBBIE N (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:BOBBIE
Middle Name:N
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 1:4466 ELVIS PRESLEY BLVD
Mailing Address - Street 2:STE.260
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38116-7180
Mailing Address - Country:US
Mailing Address - Phone:901-299-2816
Mailing Address - Fax:901-299-2816
Practice Address - Street 1:4466 ELVIS PRESLEY BLVD
Practice Address - Street 2:STE.260
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38116-7180
Practice Address - Country:US
Practice Address - Phone:901-299-2816
Practice Address - Fax:901-299-2816
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-19
Last Update Date:2008-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN00005691041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN5473Medicaid