Provider Demographics
NPI:1649553868
Name:HARRIS, STACY
Entity type:Individual
Prefix:
First Name:STACY
Middle Name:
Last Name:HARRIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 867
Mailing Address - Street 2:105 WEST 100 NORTH
Mailing Address - City:PRICE
Mailing Address - State:UT
Mailing Address - Zip Code:84501
Mailing Address - Country:US
Mailing Address - Phone:435-637-7200
Mailing Address - Fax:435-637-2377
Practice Address - Street 1:496 EAST 100 NORTH
Practice Address - Street 2:
Practice Address - City:PRICE
Practice Address - State:UT
Practice Address - Zip Code:84501-3102
Practice Address - Country:US
Practice Address - Phone:435-637-4320
Practice Address - Fax:435-637-2377
Is Sole Proprietor?:No
Enumeration Date:2011-09-23
Last Update Date:2011-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator