Provider Demographics
NPI:1942916382
Name:HARRIS, ANTANECIA
Entity Type:Individual
Prefix:
First Name:ANTANECIA
Middle Name:
Last Name:HARRIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2625 HARMONY PARK XING APT 432
Mailing Address - Street 2:
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77386-4482
Mailing Address - Country:US
Mailing Address - Phone:940-268-4502
Mailing Address - Fax:
Practice Address - Street 1:2626 HARMONY PARK XING
Practice Address - Street 2:SUITE 432
Practice Address - City:SPRING
Practice Address - State:TX
Practice Address - Zip Code:77386-4482
Practice Address - Country:US
Practice Address - Phone:979-575-1626
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-30
Last Update Date:2023-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator