=====================================================
General NPI Number Information
=====================================================
NPI Number | 1861167504
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | THE HARBOR COUNSELING & WELLNESS SERVICES, PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/13/2021
-----------------------------------------------------
Last Update Date | 08/13/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2010 NORTH LOOP W STE 115
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77018-8131
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 713-402-8909
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6031 HIGHWAY 6 N STE 165-221
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77084-2584
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 713-402-8909
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | COUNSELOR
-----------------------------------------------------
Name | YESENIA NATALY HERNANDEZ
-----------------------------------------------------
Credential | LPC
-----------------------------------------------------
Telephone | 713-402-8909
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QM0801X
-----------------------------------------------------
Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------