Provider Demographics
NPI:1174264774
Name:HARRIS, SHAUNDRA LYNETTE (MHS,MA,CADC)
Entity Type:Individual
Prefix:
First Name:SHAUNDRA
Middle Name:LYNETTE
Last Name:HARRIS
Suffix:
Gender:F
Credentials:MHS,MA,CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8839 BURR ST
Mailing Address - Street 2:
Mailing Address - City:CROWN POINT
Mailing Address - State:IN
Mailing Address - Zip Code:46307-1521
Mailing Address - Country:US
Mailing Address - Phone:708-506-2782
Mailing Address - Fax:
Practice Address - Street 1:9301 MADISON ST
Practice Address - Street 2:
Practice Address - City:CROWN POINT
Practice Address - State:IN
Practice Address - Zip Code:46307-7745
Practice Address - Country:US
Practice Address - Phone:312-662-5000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-06
Last Update Date:2022-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)