Healthcare Provider Details

I. General information

NPI: 1710455407
Provider Name (Legal Business Name): CHELSEA HARRIS MA, BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/12/2018
Last Update Date: 09/01/2021
Certification Date: 09/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

427 SPRING ST SE
GAINESVILLE GA
30501-3737
US

IV. Provider business mailing address

5336 CHASTAIN WAY
GAINESVILLE GA
30507-8150
US

V. Phone/Fax

Practice location:
  • Phone: 770-615-7676
  • Fax:
Mailing address:
  • Phone: 770-530-0147
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: