MEDICARE: THE HARBOR COUNSELING & WELLNESS SERVICES, PLLC

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	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)
2	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1861167504
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE HARBOR COUNSELING & WELLNESS SERVICES, PLLC

Provider Business Mailing Address
First Line	:	6031 HIGHWAY 6 N STE 165-221
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77084-2584
Country	:	US
Telephone Number	:	713-402-8909
Fax Number	:

Provider Business Practice Location Address
First Line	:	2010 NORTH LOOP W STE 115
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77018-8131
Country	:	US
Telephone Number	:	713-402-8909
Fax Number	:

Authorized Official
Title or Position	:	COUNSELOR
Name	:	YESENIA NATALY HERNANDEZ
Credential	:	LPC
Telephone Number	:	713-402-8909

Provider Enumeration Date	:	08/13/2021
Last Update Date	:	08/13/2021

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