MEDICARE: MARTY MILES HARRIS LPC

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	101YP2500X	Professional Counselor	62178	TX

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	:	1386896215
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARTY MILES HARRIS LPC

Provider Business Mailing Address
First Line	:	PO BOX 193
Second Line	:
City	:	BLESSING
State	:	TX
Zip	:	77419-0193
Country	:	US
Telephone Number	:	979-541-3257
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	:	979-541-3257
Fax Number	:

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

Provider Enumeration Date	:	10/22/2008
Last Update Date	:	11/07/2010

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Directions to “ MARTY MILES HARRIS LPC” Practice Location

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