Provider Demographics
NPI:1669428520
Name:HARRIS, BARBARA S
Entity type:Individual
Prefix:
First Name:BARBARA
Middle Name:S
Last Name:HARRIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:BARBARA
Other - Middle Name:S
Other - Last Name:HARRIS-MANNIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8401 OLD MCGREGOR RD
Mailing Address - Street 2:
Mailing Address - City:WACO
Mailing Address - State:TX
Mailing Address - Zip Code:76712-6495
Mailing Address - Country:US
Mailing Address - Phone:254-751-1550
Mailing Address - Fax:254-751-9291
Practice Address - Street 1:8401 OLD MCGREGOR RD
Practice Address - Street 2:
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76712-6495
Practice Address - Country:US
Practice Address - Phone:254-751-1550
Practice Address - Fax:254-751-9291
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-25
Last Update Date:2008-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX251101041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX144968804Medicaid
TX0055HCMedicare ID - Type UnspecifiedMEDICARE