Provider Demographics
NPI:1730617564
Name:HARRIS, NATASHA F (PRIMARY THERAPIST, L)
Entity type:Individual
Prefix:
First Name:NATASHA
Middle Name:F
Last Name:HARRIS
Suffix:
Gender:F
Credentials:PRIMARY THERAPIST, L
Other - Prefix:
Other - First Name:NATASHA
Other - Middle Name:F
Other - Last Name:DAVIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 1589
Mailing Address - Street 2:
Mailing Address - City:BENTON
Mailing Address - State:AR
Mailing Address - Zip Code:72018-1589
Mailing Address - Country:US
Mailing Address - Phone:501-303-3105
Mailing Address - Fax:
Practice Address - Street 1:1502 MARY KAY BLVD
Practice Address - Street 2:
Practice Address - City:BENTON
Practice Address - State:AR
Practice Address - Zip Code:72015-7201
Practice Address - Country:US
Practice Address - Phone:501-315-3344
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-24
Last Update Date:2020-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA1705207101Y00000X
ARLAC101YP2500X
ARP2001010101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY$$$$$$$$$OtherSOCIAL SECURITY