Provider Demographics
NPI:1609551357
Name:HARRIS, MATTHEW (MSSW, MSCFT, LMFT)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:
Last Name:HARRIS
Suffix:
Gender:M
Credentials:MSSW, MSCFT, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 CRESCENT AVE STE A
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40206-1512
Mailing Address - Country:US
Mailing Address - Phone:502-627-0048
Mailing Address - Fax:
Practice Address - Street 1:101 CRESCENT AVE STE A
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40206-1512
Practice Address - Country:US
Practice Address - Phone:502-627-0048
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-20
Last Update Date:2023-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY167370106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist