Healthcare Provider Details

I. General information

NPI: 1922929207
Provider Name (Legal Business Name): MATTHEW HARRIS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/23/2026
Last Update Date: 07/23/2026
Certification Date: 07/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3003 S 4TH ST
LEAVENWORTH KS
66048-5047
US

IV. Provider business mailing address

18600 E 37TH TER S
INDEPENDENCE MO
64057-1707
US

V. Phone/Fax

Practice location:
  • Phone: 913-655-2736
  • Fax:
Mailing address:
  • Phone: 816-350-0085
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: