Healthcare Provider Details

I. General information

NPI: 1417708389
Provider Name (Legal Business Name): BRIANNA N HARRIS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2024
Last Update Date: 03/28/2024
Certification Date: 03/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9089 S PECOS RD STE 3600
HENDERSON NV
89074-7186
US

IV. Provider business mailing address

9089 S PECOS RD
HENDERSON NV
89074-7183
US

V. Phone/Fax

Practice location:
  • Phone: 702-680-1526
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-22-249923
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: