Healthcare Provider Details

I. General information

NPI: 1346048170
Provider Name (Legal Business Name): HARRIS COUNSELING SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/06/2025
Last Update Date: 03/06/2025
Certification Date: 03/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

211 E INTERNATIONAL SPEEDWAY BLVD
DAYTONA BEACH FL
32118-4689
US

IV. Provider business mailing address

998 SANDLE WOOD DR
PORT ORANGE FL
32127-9337
US

V. Phone/Fax

Practice location:
  • Phone: 954-552-9773
  • Fax:
Mailing address:
  • Phone: 954-552-9773
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: BRANDON HARRIS
Title or Position: LICENSED MENTAL HEALTH COUNSELOR
Credential:
Phone: 954-552-9773