Provider Demographics
NPI:1700360344
Name:HARRIS, MEAGAN RENEE (MS)
Entity Type:Individual
Prefix:MRS
First Name:MEAGAN
Middle Name:RENEE
Last Name:HARRIS
Suffix:
Gender:F
Credentials:MS
Other - Prefix:MS
Other - First Name:MEAGAN
Other - Middle Name:RENEE
Other - Last Name:FULLERTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS
Mailing Address - Street 1:901 S BROADWAY
Mailing Address - Street 2:
Mailing Address - City:HOBART
Mailing Address - State:OK
Mailing Address - Zip Code:73651-1834
Mailing Address - Country:US
Mailing Address - Phone:580-726-3383
Mailing Address - Fax:
Practice Address - Street 1:901 S BROADWAY
Practice Address - Street 2:
Practice Address - City:HOBART
Practice Address - State:OK
Practice Address - Zip Code:73651-1834
Practice Address - Country:US
Practice Address - Phone:580-726-3383
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-19
Last Update Date:2023-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK1093897415OtherGREAT PLAINS YOUTH AND FAMILY SERVICES GRANT