Provider Demographics
NPI:1114735487
Name:HARRIS, NICOLE (MS, LPC, RPT)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:
Last Name:HARRIS
Suffix:
Gender:F
Credentials:MS, LPC, RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2311 ROBERTS DR
Mailing Address - Street 2:
Mailing Address - City:BIG SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:79720-6033
Mailing Address - Country:US
Mailing Address - Phone:432-816-0127
Mailing Address - Fax:
Practice Address - Street 1:2311 ROBERTS DR
Practice Address - Street 2:
Practice Address - City:BIG SPRING
Practice Address - State:TX
Practice Address - Zip Code:79720-6033
Practice Address - Country:US
Practice Address - Phone:432-816-0127
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-19
Last Update Date:2024-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX84351101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health