Provider Demographics
NPI:1821769134
Name:HARRIS, JOHNNY BARTHOLOMEW III (LPC)
Entity Type:Individual
Prefix:MR
First Name:JOHNNY
Middle Name:BARTHOLOMEW
Last Name:HARRIS
Suffix:III
Gender:M
Credentials:LPC
Other - Prefix:MR
Other - First Name:JOHNNY
Other - Middle Name:
Other - Last Name:HARRIS
Other - Suffix:III
Other - Last Name Type:Professional Name
Other - Credentials:LPC
Mailing Address - Street 1:6800 PARK TEN BLVD STE 200S
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78213-4293
Mailing Address - Country:US
Mailing Address - Phone:210-261-1060
Mailing Address - Fax:210-261-1060
Practice Address - Street 1:928 W COMMERCE ST
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78207-4444
Practice Address - Country:US
Practice Address - Phone:325-227-7350
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-26
Last Update Date:2023-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX81729101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional