MEDICARE: MS. JANIE EPPS HARRIS PCMHT, PH6042

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	PH6042	MS

General Provider Information

NPI Number	:	1063293728
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. JANIE EPPS HARRIS PCMHT, PH6042

Provider Business Mailing Address
First Line	:	1164 CARROLL RD
Second Line	:
City	:	PORT GIBSON
State	:	MS
Zip	:	39150-2977
Country	:	US
Telephone Number	:	601-702-9224
Fax Number	:

Provider Business Practice Location Address
First Line	:	1164 CARROLL RD
Second Line	:
City	:	PORT GIBSON
State	:	MS
Zip	:	39150-2977
Country	:	US
Telephone Number	:	601-702-9224
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/09/2023
Last Update Date	:	10/09/2023

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