Provider Demographics
NPI:1487788568
Name:HARRIS, KRISTY DAWN (MA, LPC)
Entity type:Individual
Prefix:MS
First Name:KRISTY
Middle Name:DAWN
Last Name:HARRIS
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6227 REVERE ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19149-3024
Mailing Address - Country:US
Mailing Address - Phone:215-535-7718
Mailing Address - Fax:
Practice Address - Street 1:521 MOREDON RD
Practice Address - Street 2:
Practice Address - City:HUNTINGDON VALLEY
Practice Address - State:PA
Practice Address - Zip Code:19006-7705
Practice Address - Country:US
Practice Address - Phone:215-914-4190
Practice Address - Fax:215-914-4197
Is Sole Proprietor?:No
Enumeration Date:2007-03-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC004413101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health