Healthcare Provider Details

I. General information

NPI: 1164715678
Provider Name (Legal Business Name): CAROL ANN HARRIS LPCS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/17/2011
Last Update Date: 12/11/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

156 S MAIN ST SUITE 130
LUMBERTON TX
77657-7881
US

IV. Provider business mailing address

156 S MAIN ST SUITE 130
LUMBERTON TX
77657-7881
US

V. Phone/Fax

Practice location:
  • Phone: 409-200-2220
  • Fax: 409-440-3344
Mailing address:
  • Phone: 409-200-2220
  • Fax: 409-440-3344

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number63891
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: