MEDICARE: LYNISE TAVON 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		CO

General Provider Information

NPI Number	:	1649106360
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LYNISE TAVON HARRIS

Provider Business Mailing Address
First Line	:	1354 S FULTON WAY APT F206
Second Line	:
City	:	AURORA
State	:	CO
Zip	:	80247-6388
Country	:	US
Telephone Number	:	720-603-6446
Fax Number	:

Provider Business Practice Location Address
First Line	:	1450 S HAVANA ST STE 504
Second Line	:
City	:	AURORA
State	:	CO
Zip	:	80012-5079
Country	:	US
Telephone Number	:	857-222-0424
Fax Number	:

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

Provider Enumeration Date	:	06/22/2026
Last Update Date	:	06/22/2026

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Directions to “ LYNISE TAVON HARRIS ” Practice Location

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