Provider Demographics
NPI:1487418695
Name:HARRIS, GENYSIE (ACMHC)
Entity type:Individual
Prefix:
First Name:GENYSIE
Middle Name:
Last Name:HARRIS
Suffix:
Gender:F
Credentials:ACMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:320 E VINE ST APT 6
Mailing Address - Street 2:
Mailing Address - City:MURRAY
Mailing Address - State:UT
Mailing Address - Zip Code:84107-4958
Mailing Address - Country:US
Mailing Address - Phone:314-413-5831
Mailing Address - Fax:
Practice Address - Street 1:28 N MAIN ST STE 3
Practice Address - Street 2:
Practice Address - City:TOOELE
Practice Address - State:UT
Practice Address - Zip Code:84074-2352
Practice Address - Country:US
Practice Address - Phone:801-455-0361
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-08
Last Update Date:2024-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT13741793-6009101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health