Healthcare Provider Details

I. General information

NPI: 1710591474
Provider Name (Legal Business Name): HARRIS COUNSELING & CONSULTING SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/01/2020
Last Update Date: 09/24/2020
Certification Date: 09/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3504 BLUECUTT RD
COLUMBUS MS
39705-1325
US

IV. Provider business mailing address

160 QUINN DR
COLUMBUS MS
39702-7071
US

V. Phone/Fax

Practice location:
  • Phone: 662-368-2177
  • Fax:
Mailing address:
  • Phone: 662-574-6623
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: EARNESTINE YVETT ROBY
Title or Position: OWNER/CLINICAL DIRECTOR
Credential: LPC-S, NCC, BCTMH
Phone: 662-574-6623