Provider Demographics
NPI:1932602018
Name:HARRIS, DAISETTA (QMHS)
Entity Type:Individual
Prefix:
First Name:DAISETTA
Middle Name:
Last Name:HARRIS
Suffix:
Gender:F
Credentials:QMHS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2249 ELM ST
Mailing Address - Street 2:306
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44113-2320
Mailing Address - Country:US
Mailing Address - Phone:330-531-4177
Mailing Address - Fax:
Practice Address - Street 1:3100 EAST 45 PLACE
Practice Address - Street 2:212
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44127
Practice Address - Country:US
Practice Address - Phone:216-341-5510
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-14
Last Update Date:2018-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health