Provider Demographics
NPI:1639161938
Name:HARRIS, ALAN J (PHD)
Entity Type:Individual
Prefix:
First Name:ALAN
Middle Name:J
Last Name:HARRIS
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3716 UNIVERSITY BLVD S
Mailing Address - Street 2:SUITE #6B
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32216-4355
Mailing Address - Country:US
Mailing Address - Phone:904-739-3688
Mailing Address - Fax:904-367-0250
Practice Address - Street 1:3716 UNIVERSITY BLVD S
Practice Address - Street 2:SUITE #6B
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32216-4355
Practice Address - Country:US
Practice Address - Phone:904-739-3688
Practice Address - Fax:904-367-0250
Is Sole Proprietor?:No
Enumeration Date:2005-08-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL01651900009103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist