Provider Demographics
NPI:1811641988
Name:HARRIS, IESHA (LCDC, MSW)
Entity type:Individual
Prefix:MS
First Name:IESHA
Middle Name:
Last Name:HARRIS
Suffix:
Gender:F
Credentials:LCDC, MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11575 PEARLAND PKWY APT 4208
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77089-2648
Mailing Address - Country:US
Mailing Address - Phone:832-385-9573
Mailing Address - Fax:
Practice Address - Street 1:10023 MAIN ST STE C4
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77025-5252
Practice Address - Country:US
Practice Address - Phone:713-497-5540
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-08
Last Update Date:2022-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX13578101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)