MEDICARE: REBECCA JO HARNISH LCSW, LICDC

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	116637	TX
2	101YA0400X	Addiction (Substance Use Disorder) Counselor	161016	OH

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	:	1457778862
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	REBECCA JO HARNISH LCSW, LICDC

Provider Business Mailing Address
First Line	:	19500 STATE HIGHWAY 249 STE 120
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77070-3027
Country	:	US
Telephone Number	:	844-824-8775
Fax Number	:	281-648-2200

Provider Business Practice Location Address
First Line	:	19500 STATE HIGHWAY 249 STE 120
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77070-3027
Country	:	US
Telephone Number	:	844-824-8775
Fax Number	:	281-648-2200

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

Provider Enumeration Date	:	03/24/2014
Last Update Date	:	09/03/2025

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