Healthcare Provider Details

I. General information

NPI: 1639410517
Provider Name (Legal Business Name): ALICIA HARRIS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/03/2013
Last Update Date: 03/13/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1601 E LAMAR BLVD STE 218
ARLINGTON TX
76011-4510
US

IV. Provider business mailing address

1601 E LAMAR BLVD STE 218
ARLINGTON TX
76011-4510
US

V. Phone/Fax

Practice location:
  • Phone: 469-443-6970
  • Fax:
Mailing address:
  • Phone: 469-443-6970
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: