Provider Demographics
NPI:1770108185
Name:HARRELL, TANISHA COSBY (LPC-S)
Entity type:Individual
Prefix:MRS
First Name:TANISHA
Middle Name:COSBY
Last Name:HARRELL
Suffix:
Gender:F
Credentials:LPC-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9212 FRY ROAD STE 105
Mailing Address - Street 2:PMB 208
Mailing Address - City:CYPRESS
Mailing Address - State:TX
Mailing Address - Zip Code:77433
Mailing Address - Country:US
Mailing Address - Phone:281-804-5317
Mailing Address - Fax:
Practice Address - Street 1:9212 FRY ROAD STE 105
Practice Address - Street 2:PMB 208
Practice Address - City:CYPRESS
Practice Address - State:TX
Practice Address - Zip Code:77433
Practice Address - Country:US
Practice Address - Phone:281-804-5317
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-11
Last Update Date:2020-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX19776101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty