Provider Demographics
NPI:1538488937
Name:HARRELL, RICHARD JR (MS, LPC, NCC)
Entity Type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:
Last Name:HARRELL
Suffix:JR
Gender:M
Credentials:MS, LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:148 HERITAGE LAKE DRIVE
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38109
Mailing Address - Country:US
Mailing Address - Phone:901-569-2103
Mailing Address - Fax:901-346-3110
Practice Address - Street 1:2911 BRUNSWICK RD.
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38133
Practice Address - Country:US
Practice Address - Phone:901-569-2103
Practice Address - Fax:901-346-3110
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-25
Last Update Date:2010-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNLPC0000002051101Y00000X
101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional