Provider Demographics
NPI:1861922148
Name:HARRIS, ANGELLE KEMYRA (MPA-MSW, LMSW)
Entity type:Individual
Prefix:
First Name:ANGELLE
Middle Name:KEMYRA
Last Name:HARRIS
Suffix:
Gender:F
Credentials:MPA-MSW, LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:320 WESTWAY PL STE 530
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76018-1000
Mailing Address - Country:US
Mailing Address - Phone:817-516-9100
Mailing Address - Fax:817-516-9102
Practice Address - Street 1:1880 S DAIRY ASHFORD RD STE 207
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77077-4759
Practice Address - Country:US
Practice Address - Phone:832-409-7242
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-19
Last Update Date:2025-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX114328171M00000X, 104100000X
101Y00000X
TX19899172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No172V00000XOther Service ProvidersCommunity Health Worker