Provider Demographics
NPI:1497736458
Name:HARRIS, STEPHEN ROBERT (PHD)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:ROBERT
Last Name:HARRIS
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:128 SAINT ANDREWS CIR
Mailing Address - Street 2:
Mailing Address - City:HIDEAWAY
Mailing Address - State:TX
Mailing Address - Zip Code:75771-5056
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:870-741-3457
Practice Address - Street 1:715 W SHERMAN AVE
Practice Address - Street 2:STE F
Practice Address - City:HARRISON
Practice Address - State:AR
Practice Address - Zip Code:72601-2743
Practice Address - Country:US
Practice Address - Phone:870-577-2830
Practice Address - Fax:870-741-3457
Is Sole Proprietor?:No
Enumeration Date:2005-11-08
Last Update Date:2010-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR19-76P103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR101734719Medicaid
AR101734719Medicaid