Healthcare Provider Details

I. General information

NPI: 1790502367
Provider Name (Legal Business Name): MOSHA C MYLES-HARRIS LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/24/2024
Last Update Date: 09/24/2024
Certification Date: 09/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

554 PIT RD
BROWNSBURG IN
46112-9555
US

IV. Provider business mailing address

8897 LINTON LN
BROWNSBURG IN
46112-5814
US

V. Phone/Fax

Practice location:
  • Phone: 317-742-9400
  • Fax:
Mailing address:
  • Phone: 325-518-8801
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number34008810A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: