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NPI Code Detail

MEDICARE: MADISON HARRIS

MEDICARE: MADISON HARRIS
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1106S00000XBehavior Technician
2103K00000XBehavior Analyst

General Provider Information

NPI Number : 1821674441
Entity Type Code : Individual
Provider Name (Legal Business Name) : MADISON HARRIS
Provider Business Mailing Address
First Line : 6421 CAMP BOWIE BLVD STE 100
Second Line :
City : FORT WORTH
State : TX
Zip : 76116-5419
Country : US
Telephone Number : 469-460-5237
Fax Number : 817-717-5169
Provider Business Practice Location Address
First Line : 6421 CAMP BOWIE BLVD STE 100
Second Line :
City : FORT WORTH
State : TX
Zip : 76116-5419
Country : US
Telephone Number : 469-460-5237
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/23/2021
Last Update Date : 09/15/2023

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Directions to “ MADISON HARRIS ” Practice Location

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