Provider Demographics
NPI:1881160281
Name:HARRIS, MEMENDRA PAGE (MED, LPC, NCC, MAC)
Entity type:Individual
Prefix:MRS
First Name:MEMENDRA
Middle Name:PAGE
Last Name:HARRIS
Suffix:
Gender:F
Credentials:MED, LPC, NCC, MAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:964 EXCELSIOR DR
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36117-4514
Mailing Address - Country:US
Mailing Address - Phone:334-413-2235
Mailing Address - Fax:
Practice Address - Street 1:6708 TAYLOR CIR
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36117-3411
Practice Address - Country:US
Practice Address - Phone:334-333-2744
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-23
Last Update Date:2023-10-12
Deactivation Date:2022-12-14
Deactivation Code:
Reactivation Date:2023-02-07
Provider Licenses
StateLicense IDTaxonomies
101YP2500X
AL3405101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty