Provider Demographics
NPI:1114595741
Name:HARRIS, MISHA NICOLE (MA)
Entity Type:Individual
Prefix:MS
First Name:MISHA
Middle Name:NICOLE
Last Name:HARRIS
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:42-470 KALANIANAOLE HWY
Mailing Address - Street 2:
Mailing Address - City:KAILUA
Mailing Address - State:HI
Mailing Address - Zip Code:96734-4373
Mailing Address - Country:US
Mailing Address - Phone:808-266-9932
Mailing Address - Fax:
Practice Address - Street 1:HAWAII YOUTH CORRECTIONAL FACILITY
Practice Address - Street 2:42-470 KALANIANAOLE HWY.
Practice Address - City:KAILUA
Practice Address - State:HI
Practice Address - Zip Code:96734
Practice Address - Country:US
Practice Address - Phone:808-266-9932
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-10
Last Update Date:2021-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI101YP2500X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional