Individual
COREY HARRIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
8326 KELWOOD AVE, BATON ROUGE, LA 70806-4803
(985) 492-0431
Mailing address
8326 KELWOOD AVE, BATON ROUGE, LA 70806-4803
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
007011353
DRIVER'S LICENSE
LA
Enumeration date
01/13/2020
Last updated
01/13/2020
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