Provider Demographics
NPI:1235465485
Name:HARRIS, BEVERLY JANE (RN, LPCI)
Entity type:Individual
Prefix:
First Name:BEVERLY
Middle Name:JANE
Last Name:HARRIS
Suffix:
Gender:F
Credentials:RN, LPCI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18829 TUPELO LN
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75287-2024
Mailing Address - Country:US
Mailing Address - Phone:972-765-0273
Mailing Address - Fax:
Practice Address - Street 1:8035 E R L THORNTON FWY
Practice Address - Street 2:SUITE #503
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75228-7018
Practice Address - Country:US
Practice Address - Phone:214-319-9200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-10-22
Last Update Date:2009-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX65188101YM0800X
TX517897163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health