Provider Demographics
NPI:1699531509
Name:HARRIS, ANDREW REID (MA, LPCC, LADC)
Entity type:Individual
Prefix:
First Name:ANDREW
Middle Name:REID
Last Name:HARRIS
Suffix:
Gender:M
Credentials:MA, LPCC, LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 UNION TERRACE LN N
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55441-6235
Mailing Address - Country:US
Mailing Address - Phone:612-328-7963
Mailing Address - Fax:
Practice Address - Street 1:130 UNION TERRACE LN N
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:MN
Practice Address - Zip Code:55441-6235
Practice Address - Country:US
Practice Address - Phone:612-328-7963
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-27
Last Update Date:2024-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN4190102L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes102L00000XBehavioral Health & Social Service ProvidersPsychoanalyst