Provider Demographics
NPI:1194498451
Name:HARNESS, ROY CHESTER (MSW,PCHMT,PCAT)
Entity type:Individual
Prefix:
First Name:ROY
Middle Name:CHESTER
Last Name:HARNESS
Suffix:
Gender:M
Credentials:MSW,PCHMT,PCAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1935 LAKELAND DR STE 900
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39216-5028
Mailing Address - Country:US
Mailing Address - Phone:601-718-2648
Mailing Address - Fax:601-718-2487
Practice Address - Street 1:1935 LAKELAND DR STE 900
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39216-5028
Practice Address - Country:US
Practice Address - Phone:601-718-2648
Practice Address - Fax:601-718-2487
Is Sole Proprietor?:No
Enumeration Date:2021-07-31
Last Update Date:2021-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSPA0343101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)