MEDICARE: BRENDA HARRIS LCSW

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	1041C0700X	Clinical Social Worker	29846	TX

General Provider Information

NPI Number	:	1174825723
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRENDA HARRIS LCSW

Provider Business Mailing Address
First Line	:	3013 ENCINO AVE
Second Line	:
City	:	BAY CITY
State	:	TX
Zip	:	77414-2747
Country	:	US
Telephone Number	:	979-240-5553
Fax Number	:

Provider Business Practice Location Address
First Line	:	1400 8TH ST
Second Line	:	SUITE 4A
City	:	BAY CITY
State	:	TX
Zip	:	77414-4962
Country	:	US
Telephone Number	:	979-240-5553
Fax Number	:

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

Provider Enumeration Date	:	12/01/2010
Last Update Date	:	12/01/2010

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Directions to “ BRENDA HARRIS LCSW” Practice Location

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