Healthcare Provider Details

I. General information

NPI: 1366949463
Provider Name (Legal Business Name): MOLLY ANN HARRIS LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/06/2018
Last Update Date: 10/18/2024
Certification Date: 10/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4635 SOUTHWEST FWY STE 635
HOUSTON TX
77027-7112
US

IV. Provider business mailing address

2924 KNIGHT ST STE 426
SHREVEPORT LA
71105-2414
US

V. Phone/Fax

Practice location:
  • Phone: 713-850-0049
  • Fax:
Mailing address:
  • Phone: 318-754-3560
  • Fax: 318-779-0439

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number4699
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: