Provider Demographics
NPI:1821550104
Name:HARRIS, GLENN A (QMHP)
Entity Type:Individual
Prefix:
First Name:GLENN
Middle Name:A
Last Name:HARRIS
Suffix:
Gender:M
Credentials:QMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3159 SCENIC BLUFF DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43231-3158
Mailing Address - Country:US
Mailing Address - Phone:614-897-1439
Mailing Address - Fax:
Practice Address - Street 1:3159 SCENIC BLUFF DR
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43231-3158
Practice Address - Country:US
Practice Address - Phone:614-897-1439
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-04
Last Update Date:2019-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator