Healthcare Provider Details

I. General information

NPI: 1063154011
Provider Name (Legal Business Name): HARRISON SMITH BCBA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/11/2022
Last Update Date: 03/17/2026
Certification Date: 03/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5333 MISSION CENTER RD STE 110
SAN DIEGO CA
92108-1347
US

IV. Provider business mailing address

PO BOX 740780
ATLANTA GA
30374-0780
US

V. Phone/Fax

Practice location:
  • Phone: 858-321-6286
  • Fax:
Mailing address:
  • Phone: 855-223-7123
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-26-87981
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: