Provider Demographics
NPI:1093358673
Name:HARRISON, MABLE PATRICE
Entity Type:Individual
Prefix:
First Name:MABLE
Middle Name:PATRICE
Last Name:HARRISON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6520 BROADWAY ST APT 414
Mailing Address - Street 2:
Mailing Address - City:PEARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77581-7720
Mailing Address - Country:US
Mailing Address - Phone:337-257-3216
Mailing Address - Fax:
Practice Address - Street 1:6201 BONHOMME RD STE 288N
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77036-4493
Practice Address - Country:US
Practice Address - Phone:832-862-7997
Practice Address - Fax:832-835-0722
Is Sole Proprietor?:No
Enumeration Date:2019-10-25
Last Update Date:2020-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator