MEDICARE: SHATANA SHANICE HARRIS-COBB

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	101YA0400X	Addiction (Substance Use Disorder) Counselor
2	101YM0800X	Mental Health Counselor
3	103K00000X	Behavior Analyst
4	101YP2500X	Professional Counselor

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	CP5125	OTHER	NV	LCPC
2	C10297	OTHER	NV	COUNSELOR LICENSE

General Provider Information

NPI Number	:	1104194349
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHATANA SHANICE HARRIS-COBB

Provider Business Mailing Address
First Line	:	5332 MOUNTAIN GARLAND LN
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89081-4034
Country	:	US
Telephone Number	:	661-466-8500
Fax Number	:

Provider Business Practice Location Address
First Line	:	5332 MOUNTAIN GARLAND LN
Second Line	:
City	:	N LAS VEGAS
State	:	NV
Zip	:	89081
Country	:	US
Telephone Number	:	661-466-8500
Fax Number	:

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

Provider Enumeration Date	:	12/02/2011
Last Update Date	:	01/19/2022

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