Individual
LARRY BERNARD HARRIS II
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
7647 BOULDER LN, APT. J13, INDIANAPOLIS, IN 46260-3043
(317) 500-7991
Mailing address
7647 BOULDER LN, APT. J13, INDIANAPOLIS, IN 46260-3043
(317) 500-7991
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
201057300 A
MEDICAID LEGACY PROVIDER ID
IN
Enumeration date
07/01/2014
Last updated
07/01/2014
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