Provider Demographics
NPI:1689361024
Name:HARRIS, FAITH (BS)
Entity Type:Individual
Prefix:
First Name:FAITH
Middle Name:
Last Name:HARRIS
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:113 DIAMOND CREEK DR
Mailing Address - Street 2:
Mailing Address - City:BROUSSARD
Mailing Address - State:LA
Mailing Address - Zip Code:70518-5322
Mailing Address - Country:US
Mailing Address - Phone:337-257-7038
Mailing Address - Fax:
Practice Address - Street 1:113 DIAMOND CREEK DR
Practice Address - Street 2:
Practice Address - City:BROUSSARD
Practice Address - State:LA
Practice Address - Zip Code:70518-5322
Practice Address - Country:US
Practice Address - Phone:337-257-7038
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-18
Last Update Date:2023-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator