Provider Demographics
NPI:1649819673
Name:HARRIS, MIRIAM NICOLE (PHD)
Entity type:Individual
Prefix:
First Name:MIRIAM
Middle Name:NICOLE
Last Name:HARRIS
Suffix:
Gender:
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7403 WILLOWCRAFT DR
Mailing Address - Street 2:
Mailing Address - City:MISSOURI CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77489-3380
Mailing Address - Country:US
Mailing Address - Phone:832-301-8322
Mailing Address - Fax:
Practice Address - Street 1:11281 RICHMOND AVE STE J108
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77082-2678
Practice Address - Country:US
Practice Address - Phone:832-301-3822
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-20
Last Update Date:2025-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX80000101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty