Healthcare Provider Details

I. General information

NPI: 1326625435
Provider Name (Legal Business Name): CAMILLE HARRIS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/25/2021
Last Update Date: 03/25/2021
Certification Date: 03/25/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10475 CROSSPOINT BLVD STE 250
INDIANAPOLIS IN
46256-3387
US

IV. Provider business mailing address

600 3RD AVE FL 2
NEW YORK NY
10016-1919
US

V. Phone/Fax

Practice location:
  • Phone: 615-570-9959
  • Fax: 646-859-4440
Mailing address:
  • Phone: 646-873-6600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: