Provider Demographics
NPI:1740539998
Name:HARRIS, TASA (LCSW)
Entity type:Individual
Prefix:
First Name:TASA
Middle Name:
Last Name:HARRIS
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 1:6106 MALACHI LN
Mailing Address - Street 2:
Mailing Address - City:KILLEEN
Mailing Address - State:TX
Mailing Address - Zip Code:76542-5893
Mailing Address - Country:US
Mailing Address - Phone:301-792-6224
Mailing Address - Fax:
Practice Address - Street 1:810 N W S YOUNG DR STE 107A
Practice Address - Street 2:
Practice Address - City:KILLEEN
Practice Address - State:TX
Practice Address - Zip Code:76543-4052
Practice Address - Country:US
Practice Address - Phone:254-661-3381
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-04
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCLC500794561041C0700X
TX637481041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical