Provider Demographics
NPI:1205414588
Name:HARRIS, MONIQUE YVONNE (MA, LPC, LCDC)
Entity Type:Individual
Prefix:MRS
First Name:MONIQUE
Middle Name:YVONNE
Last Name:HARRIS
Suffix:
Gender:F
Credentials:MA, LPC, LCDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5108 AIR FORCE DR
Mailing Address - Street 2:
Mailing Address - City:WICHITA FALLS
Mailing Address - State:TX
Mailing Address - Zip Code:76306-1354
Mailing Address - Country:US
Mailing Address - Phone:940-337-1565
Mailing Address - Fax:
Practice Address - Street 1:5108 AIR FORCE DR
Practice Address - Street 2:
Practice Address - City:WICHITA FALLS
Practice Address - State:TX
Practice Address - Zip Code:76306-1354
Practice Address - Country:US
Practice Address - Phone:940-337-1565
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-30
Last Update Date:2021-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX79587101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional