MEDICARE: NEQUANJA 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	101YP2500X	Professional Counselor	6451023023	MI

General Provider Information

NPI Number	:	1942993423
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NEQUANJA HARRIS

Provider Business Mailing Address
First Line	:	10450 PENNRIDGE DR
Second Line	:
City	:	PORTAGE
State	:	MI
Zip	:	49024-6728
Country	:	US
Telephone Number	:	517-282-4681
Fax Number	:

Provider Business Practice Location Address
First Line	:	3054 S 9TH ST
Second Line	:
City	:	KALAMAZOO
State	:	MI
Zip	:	49009-6250
Country	:	US
Telephone Number	:	269-332-1086
Fax Number	:

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

Provider Enumeration Date	:	05/31/2023
Last Update Date	:	05/31/2023

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