Provider Demographics
NPI:1114671294
Name:HARRIS, LA SHAUNDREA KAY ANNETTE (LPC ASSOCIATE, LCDC)
Entity Type:Individual
Prefix:
First Name:LA SHAUNDREA
Middle Name:KAY ANNETTE
Last Name:HARRIS
Suffix:
Gender:F
Credentials:LPC ASSOCIATE, LCDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 BYRON LN
Mailing Address - Street 2:
Mailing Address - City:VICTORIA
Mailing Address - State:TX
Mailing Address - Zip Code:77901-3646
Mailing Address - Country:US
Mailing Address - Phone:361-218-4653
Mailing Address - Fax:
Practice Address - Street 1:104 BYRON LN
Practice Address - Street 2:
Practice Address - City:VICTORIA
Practice Address - State:TX
Practice Address - Zip Code:77901-3646
Practice Address - Country:US
Practice Address - Phone:361-433-5527
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-08
Last Update Date:2022-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX16097101YA0400X
TX53188101YA0400X
TX87953101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)