Provider Demographics
NPI:1851099865
Name:HARRIS, REBECCA AMELIA
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:AMELIA
Last Name:HARRIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:REBECCA
Other - Middle Name:AMELIA
Other - Last Name:JAIMES
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:3500 OAK LAWN AVE STE 350
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75219-4327
Mailing Address - Country:US
Mailing Address - Phone:469-571-3470
Mailing Address - Fax:
Practice Address - Street 1:3500 OAK LAWN AVE STE 350
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75219-4327
Practice Address - Country:US
Practice Address - Phone:469-571-3470
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-20
Last Update Date:2023-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty