Provider Demographics
NPI:1841931144
Name:HARRIS, EBONIE (MHM)
Entity type:Individual
Prefix:
First Name:EBONIE
Middle Name:
Last Name:HARRIS
Suffix:
Gender:F
Credentials:MHM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3713 GLENOAK DR
Mailing Address - Street 2:
Mailing Address - City:HARVEY
Mailing Address - State:LA
Mailing Address - Zip Code:70058-1918
Mailing Address - Country:US
Mailing Address - Phone:504-405-0769
Mailing Address - Fax:
Practice Address - Street 1:3713 GLENOAK DR
Practice Address - Street 2:
Practice Address - City:HARVEY
Practice Address - State:LA
Practice Address - Zip Code:70058-1918
Practice Address - Country:US
Practice Address - Phone:504-405-0769
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-02
Last Update Date:2022-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator