Provider Demographics
NPI:1457690083
Name:HARRIS, MARY RUTH (LMSW)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:RUTH
Last Name:HARRIS
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:RUTH
Other - Last Name:CARTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMSW
Mailing Address - Street 1:710 CHIPPEWA SQ STE 208
Mailing Address - Street 2:
Mailing Address - City:MARQUETTE
Mailing Address - State:MI
Mailing Address - Zip Code:49855-4824
Mailing Address - Country:US
Mailing Address - Phone:906-235-1154
Mailing Address - Fax:
Practice Address - Street 1:710 CHIPPEWA SQ STE 208
Practice Address - Street 2:
Practice Address - City:MARQUETTE
Practice Address - State:MI
Practice Address - Zip Code:49855-4824
Practice Address - Country:US
Practice Address - Phone:906-235-1154
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-02-01
Last Update Date:2018-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010933321041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical