MEDICARE: DANELLE 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	103TH0100X	Health Service Psychologist

General Provider Information

NPI Number	:	1215795794
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DANELLE HARRIS

Provider Business Mailing Address
First Line	:	13208 TERMINAL AVE
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44135-4814
Country	:	US
Telephone Number	:	216-413-6209
Fax Number	:

Provider Business Practice Location Address
First Line	:	13208 TERMINAL AVE
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44135-4814
Country	:	US
Telephone Number	:	216-413-6209
Fax Number	:

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

Provider Enumeration Date	:	03/11/2024
Last Update Date	:	03/11/2024

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Directions to “ DANELLE HARRIS ” Practice Location

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