Provider Demographics
NPI:1245808609
Name:HARRIS, DESTINEE (BA, BT)
Entity type:Individual
Prefix:
First Name:DESTINEE
Middle Name:
Last Name:HARRIS
Suffix:
Gender:F
Credentials:BA, BT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7500 SAN FELIPE ST STE 990
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77063-1708
Mailing Address - Country:US
Mailing Address - Phone:234-255-8531
Mailing Address - Fax:
Practice Address - Street 1:805 E WASHINGTON ST STE 130
Practice Address - Street 2:
Practice Address - City:MEDINA
Practice Address - State:OH
Practice Address - Zip Code:44256-3331
Practice Address - Country:US
Practice Address - Phone:234-255-8531
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-14
Last Update Date:2025-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH106S00000X, 172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician