Individual
MYA HARRIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
3040 N 117TH ST, WAUWATOSA, WI 53222-4128
(414) 479-9990
(414) 479-0230
Mailing address
9000 W WISCONSIN AVE, MS 958, MILWAUKEE, WI 53226-4874
(414) 266-7451
(414) 266-6238
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
8343-123
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1053782003
—
WI
Enumeration date
10/16/2015
Last updated
11/12/2021
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