Provider Demographics
NPI:1538362728
Name:HARRIS, EARLENE MEAGAN (PHD)
Entity type:Individual
Prefix:MRS
First Name:EARLENE
Middle Name:MEAGAN
Last Name:HARRIS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:930 E KNAPP ST
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53202-2896
Mailing Address - Country:US
Mailing Address - Phone:414-272-3450
Mailing Address - Fax:
Practice Address - Street 1:930 E KNAPP ST
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53202-2896
Practice Address - Country:US
Practice Address - Phone:414-272-3450
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1311103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling