Healthcare Provider Details

I. General information

NPI: 1245883263
Provider Name (Legal Business Name): CHRISTINA RENEE HARRIS LPC, M.ED.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/18/2019
Last Update Date: 07/18/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24100 CHAGRIN BLVD STE 125
BEACHWOOD OH
44122-5535
US

IV. Provider business mailing address

55 E JUNIPER LN
MORELAND HILLS OH
44022-1391
US

V. Phone/Fax

Practice location:
  • Phone: 216-714-3278
  • Fax:
Mailing address:
  • Phone: 440-804-6961
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License NumberC.1902073
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: