Healthcare Provider Details

I. General information

NPI: 1568928844
Provider Name (Legal Business Name): SHANEL DAVINE HARRIS PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/12/2019
Last Update Date: 08/14/2026
Certification Date: 08/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2831 SAINT ROSE PKWY STE 237
HENDERSON NV
89052-4840
US

IV. Provider business mailing address

2831 SAINT ROSE PKWY STE 237
HENDERSON NV
89052-4840
US

V. Phone/Fax

Practice location:
  • Phone: 702-589-4712
  • Fax: 888-845-8897
Mailing address:
  • Phone: 702-589-4712
  • Fax: 888-845-8897

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number40366
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: