Healthcare Provider Details

I. General information

NPI: 1659759041
Provider Name (Legal Business Name): MARCIA HARRIS BCBA, MS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2015
Last Update Date: 05/18/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3260 EAGLE PARK DR NE SUITE 117
GRAND RAPIDS MI
49525-4569
US

IV. Provider business mailing address

7115 CHERRY VALLEY AVE SE
CALEDONIA MI
49316-8223
US

V. Phone/Fax

Practice location:
  • Phone: 616-530-2224
  • Fax:
Mailing address:
  • Phone: 616-901-3484
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-15-18391
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: