Provider Demographics
NPI:1780652685
Name:HARRIS, MARZETT CHARLES (MS, LPC, LMHC)
Entity Type:Individual
Prefix:MR
First Name:MARZETT
Middle Name:CHARLES
Last Name:HARRIS
Suffix:
Gender:M
Credentials:MS, LPC, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 CHINABERRY DR STE 900
Mailing Address - Street 2:
Mailing Address - City:BOSSIER CITY
Mailing Address - State:LA
Mailing Address - Zip Code:71111-2455
Mailing Address - Country:US
Mailing Address - Phone:318-202-3706
Mailing Address - Fax:318-202-3707
Practice Address - Street 1:34650 US HIGHWAY 19 N STE 206
Practice Address - Street 2:
Practice Address - City:PALM HARBOR
Practice Address - State:FL
Practice Address - Zip Code:34684-2157
Practice Address - Country:US
Practice Address - Phone:833-769-3524
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-08
Last Update Date:2024-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2167101YM0800X, 101YP2500X
LA3658101YM0800X, 101YP2500X
AL1829101YM0800X, 101YP2500X
101YP2500X
FLMH22029101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL339049067OtherDHR MEDICAID