Provider Demographics
NPI:1255191912
Name:SOUTHERLAND, HARMON TANNER (MS)
Entity type:Individual
Prefix:
First Name:HARMON
Middle Name:TANNER
Last Name:SOUTHERLAND
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:198 FOOTHILLS LN LOT 19
Mailing Address - Street 2:
Mailing Address - City:RUTLEDGE
Mailing Address - State:TN
Mailing Address - Zip Code:37861-3017
Mailing Address - Country:US
Mailing Address - Phone:865-606-7717
Mailing Address - Fax:
Practice Address - Street 1:1079 E MORRIS BLVD
Practice Address - Street 2:
Practice Address - City:MORRISTOWN
Practice Address - State:TN
Practice Address - Zip Code:37813-5901
Practice Address - Country:US
Practice Address - Phone:423-680-9042
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-20
Last Update Date:2024-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health