Provider Demographics
NPI:1740714153
Name:HARRIS, JOAN PHILLIPS (LPC)
Entity type:Individual
Prefix:
First Name:JOAN
Middle Name:PHILLIPS
Last Name:HARRIS
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 E MAIN ST
Mailing Address - Street 2:SUITE 305
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:TX
Mailing Address - Zip Code:78624-4203
Mailing Address - Country:US
Mailing Address - Phone:830-456-3189
Mailing Address - Fax:
Practice Address - Street 1:150 E MAIN ST
Practice Address - Street 2:SUITE 305
Practice Address - City:FREDERICKSBURG
Practice Address - State:TX
Practice Address - Zip Code:78624-4203
Practice Address - Country:US
Practice Address - Phone:830-456-3189
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-12
Last Update Date:2017-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX17015101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional