Healthcare Provider Details

I. General information

NPI: 1316603103
Provider Name (Legal Business Name): TONYA L HARRIS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/16/2021
Last Update Date: 08/31/2026
Certification Date: 08/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

421 PIONEER TRL
CEDAR SPRINGS MI
49319-8136
US

IV. Provider business mailing address

2560 ROSEWATER DR NE UNIT 219
GRAND RAPIDS MI
49525-2981
US

V. Phone/Fax

Practice location:
  • Phone: 616-260-6325
  • Fax: 616-327-4660
Mailing address:
  • Phone: 616-856-8770
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-21-175526
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: