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General NPI Number Information
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NPI Number | 1790411197
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Entity Type | Individual
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Provider Name | TERESA HARRIS LPC
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Gender | Female
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Dates
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Enumeration Date | 07/27/2022
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Last Update Date | 08/07/2023
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Provider Practice Location Address
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Address Line | 790 63RD AVE S
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City | SAINT PETERSBURG
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State | FL
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Zip | 33705-5730
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Country | US
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Telephone | 202-769-0591
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Fax |
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Provider Business Mailing Address
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Address Line | 790 63RD AVE S
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City | SAINT PETERSBURG
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State | FL
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Zip | 33705-5730
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Country | US
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Telephone | 727-359-5477
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | MH22014
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | LGP10990
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License Number State | MD
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Taxonomy #3
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | PRC200001727
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License Number State | DC
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