Provider Demographics
NPI:1518913797
Name:HARRIS, THOMAS A (EDD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:A
Last Name:HARRIS
Suffix:
Gender:M
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8401 OLD MCGREGOR RD
Mailing Address - Street 2:
Mailing Address - City:WACO
Mailing Address - State:TX
Mailing Address - Zip Code:76712-6495
Mailing Address - Country:US
Mailing Address - Phone:254-751-1550
Mailing Address - Fax:254-751-9291
Practice Address - Street 1:8401 OLD MCGREGOR RD
Practice Address - Street 2:
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76712-6495
Practice Address - Country:US
Practice Address - Phone:254-751-1550
Practice Address - Fax:254-751-9291
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-26
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX22214103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXR56237Medicare UPIN
TX00A74LMedicare ID - Type UnspecifiedMEDICARE NUMBER