MEDICARE: MS. TEAONNA D HARRIS CCHW, PBT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	146D00000X	Personal Emergency Response Attendant
2	156F00000X	Technician/Technologist
3	171400000X	Health & Wellness Coach
4	171W00000X	Contractor
5	172A00000X	Driver
6	174H00000X	Health Educator
7	221700000X	Art Therapist
8	225A00000X	Music Therapist
9	246RP1900X	Phlebotomy Technician
10	246Y00000X	Health Information Specialist/Technologist
11	251K00000X	Public Health or Welfare Agency
12	251X00000X	Supports Brokerage Agency
13	372600000X	Adult Companion
14	373H00000X	Day Training/Habilitation Specialist
15	172V00000X	Community Health Worker	0230144404	IN

General Provider Information

NPI Number	:	1053142414
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. TEAONNA D HARRIS CCHW, PBT

Provider Business Mailing Address
First Line	:	801 SHELBY ST # 513
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46203-1163
Country	:	US
Telephone Number	:	877-355-0305
Fax Number	:	317-429-1678

Provider Business Practice Location Address
First Line	:	801 SHELBY ST # 513
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46203-1163
Country	:	US
Telephone Number	:	877-355-0305
Fax Number	:	317-429-1678

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/08/2024
Last Update Date	:	08/08/2024

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