MEDICARE: HARRIS HEALTHCARE GROUP, PLLC

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	35131	TX
2	207Q00000X	Family Medicine Physician	L5000	TX

General Provider Information

NPI Number	:	1356352363
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HARRIS HEALTHCARE GROUP, PLLC

Provider Business Mailing Address
First Line	:	8323 SOUTHWEST FREEWAY
Second Line	:	SUITE 561
City	:	HOUSTON
State	:	TX
Zip	:	77074
Country	:	US
Telephone Number	:	713-665-3645
Fax Number	:	281-888-3675

Provider Business Practice Location Address
First Line	:	8323 SOUTHWEST FWY
Second Line	:	SUITE 561
City	:	HOUSTON
State	:	TX
Zip	:	77074-1615
Country	:	US
Telephone Number	:	713-574-9035
Fax Number	:	281-888-3675

Authorized Official
Title or Position	:	CHEIF EXECUTIVE OFFICER
Name	:	MR. CHARLES HARRIS SR.
Credential	:	LCSW
Telephone Number	:	713-574-9035

Provider Enumeration Date	:	08/11/2006
Last Update Date	:	06/20/2011

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