Provider Demographics
NPI:1659435550
Name:HARRISON, ESTELLE THERESA (LPC)
Entity Type:Individual
Prefix:MRS
First Name:ESTELLE
Middle Name:THERESA
Last Name:HARRISON
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:531 S 2ND ST
Mailing Address - Street 2:
Mailing Address - City:SHOW LOW
Mailing Address - State:AZ
Mailing Address - Zip Code:85901-2735
Mailing Address - Country:US
Mailing Address - Phone:928-245-1869
Mailing Address - Fax:
Practice Address - Street 1:531 S 2ND ST
Practice Address - Street 2:
Practice Address - City:SHOW LOW
Practice Address - State:AZ
Practice Address - Zip Code:85901-2735
Practice Address - Country:US
Practice Address - Phone:928-245-1869
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-22
Last Update Date:2007-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPC12265101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
WALMHC 4865OtherLIC MH COUNSELOR
AZNCC 22995OtherNAT CERT COUNSELOR
AZLPC 12265OtherLPC