Provider Demographics
NPI:1386223824
Name:HARRIS, KELLY MARIE (LMFT, LPC)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:MARIE
Last Name:HARRIS
Suffix:
Gender:F
Credentials:LMFT, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 81478
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78468-1478
Mailing Address - Country:US
Mailing Address - Phone:361-445-9957
Mailing Address - Fax:
Practice Address - Street 1:7517 MILAN ST
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78414-6142
Practice Address - Country:US
Practice Address - Phone:361-445-9957
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-02
Last Update Date:2021-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX79432101YP2500X
TX203286106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional