Provider Demographics
NPI:1922272509
Name:HARRIS, BARBARA M (MSW CLINICAL LICENSE)
Entity Type:Individual
Prefix:MRS
First Name:BARBARA
Middle Name:M
Last Name:HARRIS
Suffix:
Gender:F
Credentials:MSW CLINICAL LICENSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41 WASHINGTON ST
Mailing Address - Street 2:SUITE 320
Mailing Address - City:GRAND HAVEN
Mailing Address - State:MI
Mailing Address - Zip Code:49417
Mailing Address - Country:US
Mailing Address - Phone:616-846-0309
Mailing Address - Fax:
Practice Address - Street 1:41 WASHINGTON ST
Practice Address - Street 2:SUITE 320
Practice Address - City:GRAND HAVEN
Practice Address - State:MI
Practice Address - Zip Code:49417
Practice Address - Country:US
Practice Address - Phone:616-846-0309
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-15
Last Update Date:2008-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIOM57750Medicare PIN