Provider Demographics
NPI:1861803983
Name:HARRIS, NATHAN EUGENE III
Entity type:Individual
Prefix:
First Name:NATHAN
Middle Name:EUGENE
Last Name:HARRIS
Suffix:III
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1541 N DETROIT AVE
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74106-4208
Mailing Address - Country:US
Mailing Address - Phone:918-402-0049
Mailing Address - Fax:
Practice Address - Street 1:1 W 36TH ST N STE A
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74106-1700
Practice Address - Country:US
Practice Address - Phone:918-734-3393
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-12
Last Update Date:2014-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor