Provider Demographics
NPI:1821368069
Name:HARRIS, JUDY R (MSW , LCSW)
Entity Type:Individual
Prefix:MS
First Name:JUDY
Middle Name:R
Last Name:HARRIS
Suffix:
Gender:F
Credentials:MSW , LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:447 SW BASELINE STREET
Mailing Address - Street 2:
Mailing Address - City:HILLSBORO
Mailing Address - State:OR
Mailing Address - Zip Code:97123
Mailing Address - Country:US
Mailing Address - Phone:503-640-4222
Mailing Address - Fax:503-640-0334
Practice Address - Street 1:447 SE BASELINE ST
Practice Address - Street 2:
Practice Address - City:HILLSBORO
Practice Address - State:OR
Practice Address - Zip Code:97123-4103
Practice Address - Country:US
Practice Address - Phone:503-640-4222
Practice Address - Fax:503-640-0334
Is Sole Proprietor?:No
Enumeration Date:2012-01-05
Last Update Date:2012-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR4611041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical