Provider Demographics
NPI:1245802735
Name:HARRIS, MATTHEW C (LPC)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:C
Last Name:HARRIS
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:154 FORREST DR
Mailing Address - Street 2:
Mailing Address - City:HANNIBAL
Mailing Address - State:MO
Mailing Address - Zip Code:63401-5511
Mailing Address - Country:US
Mailing Address - Phone:573-221-2120
Mailing Address - Fax:573-221-4380
Practice Address - Street 1:154 FORREST DR
Practice Address - Street 2:
Practice Address - City:HANNIBAL
Practice Address - State:MO
Practice Address - Zip Code:63401-5511
Practice Address - Country:US
Practice Address - Phone:573-221-2120
Practice Address - Fax:573-221-4380
Is Sole Proprietor?:No
Enumeration Date:2021-07-14
Last Update Date:2021-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2018040812101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional