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NPI Code Detail

MEDICARE: JOHNNY MARCUS HARRIS

MEDICARE: JOHNNY MARCUS 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
1101Y00000XCounselorCG61291896WA

General Provider Information

NPI Number : 1689522104
Entity Type Code : Individual
Provider Name (Legal Business Name) : JOHNNY MARCUS HARRIS
Provider Business Mailing Address
First Line : 2428 W REYNOLDS AVE
Second Line :
City : CENTRALIA
State : WA
Zip : 98531-4554
Country : US
Telephone Number : 360-330-9044
Fax Number : 360-736-0689
Provider Business Practice Location Address
First Line : 2428 W REYNOLDS AVE
Second Line :
City : CENTRALIA
State : WA
Zip : 98531-4554
Country : US
Telephone Number : 360-330-9044
Fax Number : 360-736-0689
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/19/2026
Last Update Date : 03/19/2026

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Directions to “ JOHNNY MARCUS HARRIS ” Practice Location

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