Provider Demographics
NPI:1194749457
Name:HARRIS, TIMOTHY BRETT (PHD CCCSLP)
Entity type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:BRETT
Last Name:HARRIS
Suffix:
Gender:M
Credentials:PHD CCCSLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 UNIVERSITY HALL DRIVE
Mailing Address - Street 2:ROOM 120
Mailing Address - City:BOONE
Mailing Address - State:NC
Mailing Address - Zip Code:28608-2041
Mailing Address - Country:US
Mailing Address - Phone:828-262-2185
Mailing Address - Fax:828-262-6766
Practice Address - Street 1:400 UNIVERSITY HALL DRIVE
Practice Address - Street 2:ROOM 120
Practice Address - City:BOONE
Practice Address - State:NC
Practice Address - Zip Code:28608-2041
Practice Address - Country:US
Practice Address - Phone:828-262-2185
Practice Address - Fax:828-262-6766
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2008-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1747235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC40009OtherBCBS OF NC
NC7411018Medicaid