MEDICARE: MS. MARI ALFIERI HARRIS LAC

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	101YA0400X	Addiction (Substance Use Disorder) Counselor	955	LA

General Provider Information

NPI Number	:	1700818887
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MARI ALFIERI HARRIS LAC

Provider Business Mailing Address
First Line	:	5801 BERWICK LN
Second Line	:
City	:	LAKE CHARLES
State	:	LA
Zip	:	70605-7127
Country	:	US
Telephone Number	:	337-474-5596
Fax Number	:

Provider Business Practice Location Address
First Line	:	3505 5TH AVE
Second Line	:	SUITE B
City	:	LAKE CHARLES
State	:	LA
Zip	:	70607-2156
Country	:	US
Telephone Number	:	337-475-4855
Fax Number	:	337-475-4858

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

Provider Enumeration Date	:	07/07/2006
Last Update Date	:	07/08/2007

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