Provider Demographics
NPI:1053144253
Name:HARRIS, KOURTNEY JR
Entity type:Individual
Prefix:
First Name:KOURTNEY
Middle Name:
Last Name:HARRIS
Suffix:JR
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 1:400 GALLOWAY ST NE APT 536S
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20011-6437
Mailing Address - Country:US
Mailing Address - Phone:337-706-6057
Mailing Address - Fax:
Practice Address - Street 1:400 GALLOWAY ST NE APT 536S
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20011-6437
Practice Address - Country:US
Practice Address - Phone:337-706-6057
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-22
Last Update Date:2024-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCLGPC200001732101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health