Provider Demographics
NPI:1306176722
Name:HARRIS, BRANDI K (MS)
Entity type:Individual
Prefix:
First Name:BRANDI
Middle Name:K
Last Name:HARRIS
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6815 ISAACS ORCHARD RD
Mailing Address - Street 2:SUITE B1
Mailing Address - City:SPRINGDALE
Mailing Address - State:AR
Mailing Address - Zip Code:72762-6324
Mailing Address - Country:US
Mailing Address - Phone:918-261-3194
Mailing Address - Fax:877-884-4583
Practice Address - Street 1:6815 ISAACS ORCHARD RD
Practice Address - Street 2:SUITE B1
Practice Address - City:SPRINGDALE
Practice Address - State:AR
Practice Address - Zip Code:72762-6324
Practice Address - Country:US
Practice Address - Phone:918-261-3194
Practice Address - Fax:877-884-4583
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-07
Last Update Date:2015-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK987106H00000X
ARP1510114101YP2500X
ARM1510008106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200311390AMedicaid