Provider Demographics
NPI:1649438359
Name:HARRISS CENTER FOR COUNSELING AND DEVELOPMENT, PA
Entity type:Organization
Organization Name:HARRISS CENTER FOR COUNSELING AND DEVELOPMENT, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:HARRISS
Authorized Official - Suffix:
Authorized Official - Credentials:RN, MA, MED, LPC
Authorized Official - Phone:325-646-2155
Mailing Address - Street 1:PO BOX 505
Mailing Address - Street 2:
Mailing Address - City:BROWNWOOD
Mailing Address - State:TX
Mailing Address - Zip Code:76804-0505
Mailing Address - Country:US
Mailing Address - Phone:325-646-2155
Mailing Address - Fax:325-643-1105
Practice Address - Street 1:2421 AUSTIN AVE
Practice Address - Street 2:
Practice Address - City:BROWNWOOD
Practice Address - State:TX
Practice Address - Zip Code:76801-4929
Practice Address - Country:US
Practice Address - Phone:325-646-2155
Practice Address - Fax:325-643-1105
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-29
Last Update Date:2008-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX12723101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0265399-01Medicaid
TX2889LCOtherBLUE CROSS AND BLUE SHIELD