Provider Demographics
NPI:1619125648
Name:HARRISON, JANET LISA (LPC-MHSP)
Entity Type:Individual
Prefix:
First Name:JANET
Middle Name:LISA
Last Name:HARRISON
Suffix:
Gender:F
Credentials:LPC-MHSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3069 BROAD ST
Mailing Address - Street 2:SUITE 9
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37408-3047
Mailing Address - Country:US
Mailing Address - Phone:423-266-7479
Mailing Address - Fax:
Practice Address - Street 1:3069 BROAD ST
Practice Address - Street 2:SUITE 9
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37408-3047
Practice Address - Country:US
Practice Address - Phone:423-266-7479
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-03
Last Update Date:2008-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNLPC 1993101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNLPC 1993OtherPROFESSIONAL LICENSE NUMBER
4159517OtherINSURANCE PROVIDER IDENTIFICATION NUMBER