Provider Demographics
NPI:1508423930
Name:HARRIS, JESSICA M (LMFT)
Entity type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:M
Last Name:HARRIS
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9108 TAMARACK GROVE LN
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40291-4333
Mailing Address - Country:US
Mailing Address - Phone:502-822-0811
Mailing Address - Fax:
Practice Address - Street 1:4229 BARDSTOWN RD STE 307
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40218-4270
Practice Address - Country:US
Practice Address - Phone:502-822-0811
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-21
Last Update Date:2024-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY251255106H00000X
171M00000X
KY294201106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No171M00000XOther Service ProvidersCase Manager/Care Coordinator