Provider Demographics
NPI:1811739212
Name:HARRIS, HOUSTON LEE
Entity type:Individual
Prefix:
First Name:HOUSTON
Middle Name:LEE
Last Name:HARRIS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1982
Mailing Address - Street 2:
Mailing Address - City:ARDMORE
Mailing Address - State:OK
Mailing Address - Zip Code:73402-1982
Mailing Address - Country:US
Mailing Address - Phone:580-319-5770
Mailing Address - Fax:580-319-7086
Practice Address - Street 1:PO BOX 1982
Practice Address - Street 2:
Practice Address - City:ARDMORE
Practice Address - State:OK
Practice Address - Zip Code:73402-1982
Practice Address - Country:US
Practice Address - Phone:580-319-5770
Practice Address - Fax:580-319-7086
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-07
Last Update Date:2024-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1123539106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician