Provider Demographics
NPI:1922129733
Name:HARRIS, ANNE ROSS (LCPC)
Entity Type:Individual
Prefix:MS
First Name:ANNE
Middle Name:ROSS
Last Name:HARRIS
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4803 CALVIN CT
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59808-9673
Mailing Address - Country:US
Mailing Address - Phone:406-240-9057
Mailing Address - Fax:406-493-0809
Practice Address - Street 1:4803 CALVIN CT
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59808-9673
Practice Address - Country:US
Practice Address - Phone:406-240-9057
Practice Address - Fax:406-493-0809
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-02
Last Update Date:2024-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT104101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT743540OtherBC & BS
MT256666Medicaid
MT251368Medicaid