Provider Demographics
NPI:1811725591
Name:HARRIS, SHANTAE RAVEN (LMFT)
Entity type:Individual
Prefix:MRS
First Name:SHANTAE
Middle Name:RAVEN
Last Name:HARRIS
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:554 INDIAN CV
Mailing Address - Street 2:
Mailing Address - City:CORDOVA
Mailing Address - State:TN
Mailing Address - Zip Code:38018-7675
Mailing Address - Country:US
Mailing Address - Phone:719-321-8282
Mailing Address - Fax:
Practice Address - Street 1:554 INDIAN CV
Practice Address - Street 2:
Practice Address - City:CORDOVA
Practice Address - State:TN
Practice Address - Zip Code:38018-7675
Practice Address - Country:US
Practice Address - Phone:901-426-5466
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-23
Last Update Date:2024-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNLMT0000002344101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional