Provider Demographics
NPI:1912361726
Name:HARRIS, ROSETTA (MHS,CPHT,CMA)
Entity Type:Individual
Prefix:
First Name:ROSETTA
Middle Name:
Last Name:HARRIS
Suffix:
Gender:F
Credentials:MHS,CPHT,CMA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:656 W NIAGARA CIR
Mailing Address - Street 2:
Mailing Address - City:GRETNA
Mailing Address - State:LA
Mailing Address - Zip Code:70056-2938
Mailing Address - Country:US
Mailing Address - Phone:504-913-6854
Mailing Address - Fax:
Practice Address - Street 1:656 W NIAGARA CIR
Practice Address - Street 2:
Practice Address - City:GRETNA
Practice Address - State:LA
Practice Address - Zip Code:70056-2938
Practice Address - Country:US
Practice Address - Phone:504-913-6854
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-07
Last Update Date:2017-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health