Healthcare Provider Details

I. General information

NPI: 1295655009
Provider Name (Legal Business Name): ERIC JERONE HARRISON
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/20/2026
Last Update Date: 07/20/2026
Certification Date: 07/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3430 E FLAMINGO RD STE 324
LAS VEGAS NV
89121-5067
US

IV. Provider business mailing address

6016 BROMLEY AVE APT 8
LAS VEGAS NV
89107-1543
US

V. Phone/Fax

Practice location:
  • Phone: 725-270-6649
  • Fax:
Mailing address:
  • Phone: 725-270-6649
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License NumberPRSS-5412
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: