Provider Demographics
NPI:1922821404
Name:HARRISON, EMILY ALYN (LCDC)
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:ALYN
Last Name:HARRISON
Suffix:
Gender:F
Credentials:LCDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:644 FAIRWAY
Mailing Address - Street 2:
Mailing Address - City:KYLE
Mailing Address - State:TX
Mailing Address - Zip Code:78640-8755
Mailing Address - Country:US
Mailing Address - Phone:512-620-2256
Mailing Address - Fax:
Practice Address - Street 1:2015 NE LOOP 410
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78217-5411
Practice Address - Country:US
Practice Address - Phone:512-620-2256
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-04
Last Update Date:2024-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX15480101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)