Provider Demographics
NPI:1558144352
Name:HARRIS, DECLAN (NCC)
Entity Type:Individual
Prefix:
First Name:DECLAN
Middle Name:
Last Name:HARRIS
Suffix:
Gender:M
Credentials:NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1700 STATE ST APT 201
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37203-3009
Mailing Address - Country:US
Mailing Address - Phone:831-402-7991
Mailing Address - Fax:
Practice Address - Street 1:1305 16TH AVE S
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37212-2923
Practice Address - Country:US
Practice Address - Phone:831-402-7991
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-15
Last Update Date:2023-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty