Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 102L00000X | Psychologist | PS018212 | PA |
Y | 103T00000X | Psychologist | PS018212 | PA |
NPI | 1003353954 |
---|---|
Provider Name | Joel Harris |
First Address | Philipsburg, PA 16866-8112 |
Second Address | Philipsburg, PA 16866-8112 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/01/2017 |
Last Update Date | 30/01/2017 |