MEDICARE: MIRIAM NICOLE HARRIS

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	251B00000X	Case Management Agency	80000	TX
2	101YP2500X	Professional Counselor	80000	TX

General Provider Information

NPI Number	:	1649819673
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MIRIAM NICOLE HARRIS

Provider Business Mailing Address
First Line	:	7403 WILLOWCRAFT DR
Second Line	:
City	:	MISSOURI CITY
State	:	TX
Zip	:	77489-3380
Country	:	US
Telephone Number	:	832-301-8322
Fax Number	:

Provider Business Practice Location Address
First Line	:	11281 RICHMOND AVE STE J108
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77082-2678
Country	:	US
Telephone Number	:	832-301-3822
Fax Number	:

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

Provider Enumeration Date	:	12/20/2019
Last Update Date	:	06/01/2026

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