Basic Information
| Provider Information | |||||||||
| NPI: | 1003014085 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HARRIS | ||||||||
| FirstName: | PAMELA | ||||||||
| MiddleName: | RENEE | ||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | LPCC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1208 MELBOURNE RD | ||||||||
| Address2: | |||||||||
| City: | EAST CLEVELAND | ||||||||
| State: | OH | ||||||||
| PostalCode: | 441124137 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2168512541 | ||||||||
| FaxNumber: | 2168512541 | ||||||||
| Practice Location | |||||||||
| Address1: | 670 BROADWAY AVE | ||||||||
| Address2: | |||||||||
| City: | BEDFORD | ||||||||
| State: | OH | ||||||||
| PostalCode: | 441463642 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4404399250 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/11/2007 | ||||||||
| LastUpdateDate: | 07/11/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YP2500X | E 0007152 | OH | Y | Behavioral Health & Social Service Providers | Counselor | Professional |
No ID Information.