Provider Demographics
NPI:1801314331
Name:HARRIS, THOMAS BENJAMIN (PLPC)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:BENJAMIN
Last Name:HARRIS
Suffix:
Gender:M
Credentials:PLPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4132 KEATON CROSSING BLVD STE 204
Mailing Address - Street 2:
Mailing Address - City:O FALLON
Mailing Address - State:MO
Mailing Address - Zip Code:63368-8223
Mailing Address - Country:US
Mailing Address - Phone:636-627-9136
Mailing Address - Fax:
Practice Address - Street 1:4132 KEATON CROSSING BLVD STE 204
Practice Address - Street 2:
Practice Address - City:O FALLON
Practice Address - State:MO
Practice Address - Zip Code:63368-8223
Practice Address - Country:US
Practice Address - Phone:636-627-9136
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-05
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2016014344101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional