Provider Demographics
NPI:1063293728
Name:HARRIS, JANIE EPPS (PCMHT, PH6042)
Entity type:Individual
Prefix:MS
First Name:JANIE
Middle Name:EPPS
Last Name:HARRIS
Suffix:
Gender:F
Credentials:PCMHT, PH6042
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1164 CARROLL RD
Mailing Address - Street 2:
Mailing Address - City:PORT GIBSON
Mailing Address - State:MS
Mailing Address - Zip Code:39150-2977
Mailing Address - Country:US
Mailing Address - Phone:601-702-9224
Mailing Address - Fax:
Practice Address - Street 1:1164 CARROLL RD
Practice Address - Street 2:
Practice Address - City:PORT GIBSON
Practice Address - State:MS
Practice Address - Zip Code:39150-2977
Practice Address - Country:US
Practice Address - Phone:601-702-9224
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-09
Last Update Date:2023-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSPH6042101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health