Provider Demographics
NPI:1992937999
Name:HARRIS, RICK R (SAC)
Entity type:Individual
Prefix:
First Name:RICK
Middle Name:R
Last Name:HARRIS
Suffix:
Gender:M
Credentials:SAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:285 N JANACEK RD
Mailing Address - Street 2:
Mailing Address - City:BROOKFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53045-6102
Mailing Address - Country:US
Mailing Address - Phone:262-641-9050
Mailing Address - Fax:262-641-9126
Practice Address - Street 1:2314 N GRANDVIEW BLVD
Practice Address - Street 2:SUITE 301 & 110
Practice Address - City:WAUKESHA
Practice Address - State:WI
Practice Address - Zip Code:53188-1675
Practice Address - Country:US
Practice Address - Phone:262-524-9416
Practice Address - Fax:262-524-9434
Is Sole Proprietor?:No
Enumeration Date:2009-08-10
Last Update Date:2011-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI15637-131101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)