Provider Demographics
NPI:1053142414
Name:HARRIS, TEAONNA D (CCHW, PBT)
Entity type:Individual
Prefix:MS
First Name:TEAONNA
Middle Name:D
Last Name:HARRIS
Suffix:
Gender:F
Credentials:CCHW, PBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:801 SHELBY ST # 513
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46203-1163
Mailing Address - Country:US
Mailing Address - Phone:877-355-0305
Mailing Address - Fax:317-429-1678
Practice Address - Street 1:801 SHELBY ST # 513
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46203-1163
Practice Address - Country:US
Practice Address - Phone:877-355-0305
Practice Address - Fax:317-429-1678
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-08
Last Update Date:2024-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
146D00000X, 156F00000X, 171400000X, 171W00000X, 172A00000X, 174H00000X, 221700000X, 225A00000X, 246RP1900X, 246Y00000X, 251K00000X, 251X00000X, 372600000X, 373H00000X
IN0230144404172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes172V00000XOther Service ProvidersCommunity Health WorkerGroup - Multi-Specialty
No146D00000XEmergency Medical Service ProvidersPersonal Emergency Response AttendantGroup - Multi-Specialty
No156F00000XEye and Vision Services ProvidersTechnician/TechnologistGroup - Multi-Specialty
No171400000XOther Service ProvidersHealth & Wellness Coach
No171W00000XOther Service ProvidersContractorGroup - Multi-Specialty
No172A00000XOther Service ProvidersDriverGroup - Multi-Specialty
No174H00000XOther Service ProvidersHealth EducatorGroup - Multi-Specialty
No221700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersArt TherapistGroup - Multi-Specialty
No225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic Therapist
No246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomy
No246Y00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, Health InformationGroup - Multi-Specialty
No251K00000XAgenciesPublic Health or Welfare
No251X00000XAgenciesSupports Brokerage
No372600000XNursing Service Related ProvidersAdult Companion
No373H00000XNursing Service Related ProvidersDay Training/Habilitation SpecialistGroup - Multi-Specialty