Provider Demographics
NPI:1700860723
Name:HARRIS, THOMAS R (LPC)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:R
Last Name:HARRIS
Suffix:
Gender:M
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:PO BOX 1992
Mailing Address - Street 2:
Mailing Address - City:DUMAS
Mailing Address - State:TX
Mailing Address - Zip Code:79029-1992
Mailing Address - Country:US
Mailing Address - Phone:806-935-8451
Mailing Address - Fax:806-934-1851
Practice Address - Street 1:310 S BLISS AVE
Practice Address - Street 2:
Practice Address - City:DUMAS
Practice Address - State:TX
Practice Address - Zip Code:79029-3833
Practice Address - Country:US
Practice Address - Phone:806-935-8451
Practice Address - Fax:806-934-1851
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX12898101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX3637LCOtherBLUE CROSS BLUE SHIELD