Healthcare Provider Details

I. General information

NPI: 1003729054
Provider Name (Legal Business Name): JILLIAN LEIGH HARRIS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/22/2026
Last Update Date: 09/22/2026
Certification Date: 09/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

183 WESTFIELD LOOP
LUFKIN TX
75904-6711
US

IV. Provider business mailing address

1670 N HAMPTON RD STE 106
DESOTO TX
75115-2389
US

V. Phone/Fax

Practice location:
  • Phone: 936-465-2584
  • Fax:
Mailing address:
  • Phone: 430-235-5611
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-16-21726
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: