MEDICARE: JACQUELINE 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	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1427346915
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JACQUELINE HARRIS

Provider Business Mailing Address
First Line	:	10190 KATY FWY STE 351
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77043-5239
Country	:	US
Telephone Number	:	832-675-2275
Fax Number	:

Provider Business Practice Location Address
First Line	:	10190 KATY FWY
Second Line	:	STE 351
City	:	HOUSTON
State	:	TX
Zip	:	77043-5239
Country	:	US
Telephone Number	:	832-675-2275
Fax Number	:

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

Provider Enumeration Date	:	07/18/2011
Last Update Date	:	07/18/2011

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Directions to “ JACQUELINE HARRIS ” Practice Location

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