MEDICARE: LILLIAN HARRIS

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	104100000X	Social Worker

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1154728939
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LILLIAN HARRIS

Provider Business Mailing Address
First Line	:	3260 FOUNTAIN FALLS WAY
Second Line	:	#1170
City	:	N LAS VEGAS
State	:	NV
Zip	:	89032-2225
Country	:	US
Telephone Number	:	702-218-8078
Fax Number	:

Provider Business Practice Location Address
First Line	:	3260 FOUNTAIN FALLS WAY
Second Line	:	#1170
City	:	N LAS VEGAS
State	:	NV
Zip	:	89032-2225
Country	:	US
Telephone Number	:	702-218-8078
Fax Number	:

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

Provider Enumeration Date	:	11/22/2014
Last Update Date	:	11/22/2014

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Directions to “ LILLIAN HARRIS ” Practice Location

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