Provider Demographics
NPI:1972139574
Name:HARRIS, WALTER ROBERT (ME)
Entity Type:Individual
Prefix:
First Name:WALTER
Middle Name:ROBERT
Last Name:HARRIS
Suffix:
Gender:M
Credentials:ME
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 STONECREST CT
Mailing Address - Street 2:
Mailing Address - City:SHELBYVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40065-8128
Mailing Address - Country:US
Mailing Address - Phone:502-232-0893
Mailing Address - Fax:502-324-7057
Practice Address - Street 1:30 STONECREST CT
Practice Address - Street 2:
Practice Address - City:SHELBYVILLE
Practice Address - State:KY
Practice Address - Zip Code:40065-8128
Practice Address - Country:US
Practice Address - Phone:502-437-0859
Practice Address - Fax:502-324-7057
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-16
Last Update Date:2020-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)