Provider Demographics
NPI:1902915150
Name:HARRIS, GEORGE ALBERT (PHD)
Entity Type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:ALBERT
Last Name:HARRIS
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8080 WARD PARKWAY
Mailing Address - Street 2:SUITE 140
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64114-2132
Mailing Address - Country:US
Mailing Address - Phone:816-361-3404
Mailing Address - Fax:816-361-2084
Practice Address - Street 1:8080 WARD PARKWAY
Practice Address - Street 2:SUITE 140
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64114-2132
Practice Address - Country:US
Practice Address - Phone:816-361-3404
Practice Address - Fax:816-361-2084
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO508103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOP13321Medicare UPIN
MO0005287Medicare ID - Type Unspecified