Provider Demographics
NPI:1528898509
Name:HARRIS, KOURTNEY ELAYNE (LSW)
Entity type:Individual
Prefix:
First Name:KOURTNEY
Middle Name:ELAYNE
Last Name:HARRIS
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1875 HAYMAKER RD
Mailing Address - Street 2:
Mailing Address - City:MONROEVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:15146-4751
Mailing Address - Country:US
Mailing Address - Phone:319-230-9849
Mailing Address - Fax:
Practice Address - Street 1:40 HUFF AVENUE EXT BLDG 1
Practice Address - Street 2:
Practice Address - City:GREENSBURG
Practice Address - State:PA
Practice Address - Zip Code:15601-5484
Practice Address - Country:US
Practice Address - Phone:724-302-0804
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-05
Last Update Date:2024-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW1416121041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty