Provider Demographics
NPI:1538349907
Name:HARRISON, PATRICE DOUGLISA
Entity type:Individual
Prefix:
First Name:PATRICE
Middle Name:DOUGLISA
Last Name:HARRISON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1033 SECRETARIAT DR
Mailing Address - Street 2:
Mailing Address - City:TERRELL
Mailing Address - State:TX
Mailing Address - Zip Code:75160-7377
Mailing Address - Country:US
Mailing Address - Phone:972-552-3735
Mailing Address - Fax:972-552-3735
Practice Address - Street 1:1033 SECRETARIAT DR
Practice Address - Street 2:
Practice Address - City:TERRELL
Practice Address - State:TX
Practice Address - Zip Code:75160-7377
Practice Address - Country:US
Practice Address - Phone:972-552-3735
Practice Address - Fax:972-552-3735
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-14
Last Update Date:2007-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX504881041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical