Provider Demographics
NPI:1104010701
Name:HARRIS, KEONA RESHEA (MS)
Entity type:Individual
Prefix:MRS
First Name:KEONA
Middle Name:RESHEA
Last Name:HARRIS
Suffix:
Gender:F
Credentials:MS
Other - Prefix:MISS
Other - First Name:KEONA
Other - Middle Name:RESHEA
Other - Last Name:LITTLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS
Mailing Address - Street 1:1 HIDDEN VALLEY DR APT D1
Mailing Address - Street 2:
Mailing Address - City:TUPELO
Mailing Address - State:MS
Mailing Address - Zip Code:38801-5667
Mailing Address - Country:US
Mailing Address - Phone:662-842-4504
Mailing Address - Fax:662-844-0780
Practice Address - Street 1:2434 S EASON BLVD
Practice Address - Street 2:
Practice Address - City:TUPELO
Practice Address - State:MS
Practice Address - Zip Code:38804-6942
Practice Address - Country:US
Practice Address - Phone:662-844-1717
Practice Address - Fax:662-680-5129
Is Sole Proprietor?:No
Enumeration Date:2007-08-28
Last Update Date:2007-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health