Provider Demographics
NPI:1669712972
Name:HARRIS, JUDITH LEE
Entity type:Individual
Prefix:MS
First Name:JUDITH
Middle Name:LEE
Last Name:HARRIS
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:JUDITH
Other - Middle Name:HARRIS
Other - Last Name:ANDRISON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:907 E 36TH ST
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74105-3047
Mailing Address - Country:US
Mailing Address - Phone:918-749-8877
Mailing Address - Fax:
Practice Address - Street 1:907 E 36TH ST
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74105-3047
Practice Address - Country:US
Practice Address - Phone:918-749-8877
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-02-22
Last Update Date:2013-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK$$$$$$$$$AMedicare PIN