Provider Demographics
NPI:1699160945
Name:HARRIS, PATRICIA (EDD)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:
Last Name:HARRIS
Suffix:
Gender:F
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:605 BRIDGEVIEW ST
Mailing Address - Street 2:
Mailing Address - City:BRIDGE CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77611-4008
Mailing Address - Country:US
Mailing Address - Phone:409-791-5071
Mailing Address - Fax:
Practice Address - Street 1:4400 MLK BLVD, EDUCATION BLDG, RM 115
Practice Address - Street 2:LAMAR UNIVERSITY CARDINAL COMMUNITY CLINIC
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77710
Practice Address - Country:US
Practice Address - Phone:409-880-7681
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-03
Last Update Date:2015-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX70403101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor