Provider Demographics
NPI:1457390288
Name:HARRISS, CHRISTIE SHAWN (LCSW)
Entity Type:Individual
Prefix:
First Name:CHRISTIE
Middle Name:SHAWN
Last Name:HARRISS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1905 MARSHALL ST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77098-2703
Mailing Address - Country:US
Mailing Address - Phone:832-814-2174
Mailing Address - Fax:713-526-1452
Practice Address - Street 1:2825 WILCREST DR
Practice Address - Street 2:SUITE 162
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77042-3391
Practice Address - Country:US
Practice Address - Phone:832-814-2174
Practice Address - Fax:713-526-1452
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX363211041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX611808Medicare ID - Type Unspecified