Jennifer L Harris, BA PSYCHOLOGY

Primary specialty

Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X

Practice address

104 George Bishop Pkwy
Myrtle Beach, SC 29579-7335

Phone

(828) 291-4460

NPI assigned

Jun 14, 2023

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Bachelor of Arts

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1686700800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1686787200000",
    "number": "1831873330",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12 LAKESIDE AVE",
            "city": "GRANITE FALLS",
            "state": "NC",
            "postal_code": "286301723",
            "telephone_number": "828-291-4460"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "104 GEORGE BISHOP PKWY",
            "city": "MYRTLE BEACH",
            "state": "SC",
            "postal_code": "295797335",
            "telephone_number": "828-291-4460"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HARRIS",
        "first_name": "JENNIFER",
        "middle_name": "L",
        "credential": "BA PSYCHOLOGY",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2023-06-14",
        "last_updated": "2023-06-15",
        "certification_date": "2023-06-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QM2800X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Methadone",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kerry J Harrah, MA, LPC
• Stephen Harrell, H.I.S
• Sandra K. Harrill
• Janet E Harris-Hicks, M.D.
• Cassie Harris, RD
• Lacey Autumn Harris, PTA
• Bernadette Lee Harrold, CRNA
• Brian C Harsha, DDS
• Janice L Hart, DO
• Jennifer Hart

• Federally Qualified Health Center (FQHC) in Myrtle Beach, SC
• Providers in Myrtle Beach, SC by specialty
• Federally Qualified Health Center (FQHC) in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 15, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.