Provider Demographics
NPI:1982118766
Name:HARRIS, LENA SIMONE (LPC)
Entity type:Individual
Prefix:
First Name:LENA
Middle Name:SIMONE
Last Name:HARRIS
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7519 MENTOR AVE STE 114
Mailing Address - Street 2:
Mailing Address - City:MENTOR
Mailing Address - State:OH
Mailing Address - Zip Code:44060-5410
Mailing Address - Country:US
Mailing Address - Phone:440-701-6170
Mailing Address - Fax:440-527-8043
Practice Address - Street 1:7519 MENTOR AVE STE 114
Practice Address - Street 2:
Practice Address - City:MENTOR
Practice Address - State:OH
Practice Address - Zip Code:44060-5410
Practice Address - Country:US
Practice Address - Phone:440-701-6170
Practice Address - Fax:440-527-8043
Is Sole Proprietor?:No
Enumeration Date:2017-12-01
Last Update Date:2022-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHC.1801143101YP2500X
171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0288391Medicaid