Healthcare Provider Details

I. General information

NPI: 1871239418
Provider Name (Legal Business Name): DAKOTA KANAE TAHISA HARRIS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/06/2022
Last Update Date: 05/06/2022
Certification Date: 05/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5550 OLD SHELL RD
MOBILE AL
36608-3039
US

IV. Provider business mailing address

1070 PLEASANT VALLEY RD
HAZLEHURST MS
39083-8718
US

V. Phone/Fax

Practice location:
  • Phone: 251-287-2442
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: