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General NPI Number Information
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NPI Number | 1265840219
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Entity Type | Organization
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Legal Business Name | BRANDON HARRIS
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Dates
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Enumeration Date | 07/22/2014
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Last Update Date | 07/22/2014
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Provider Practice Location Address
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Address Line | 5640 PACIFIC BLVD APT 1035
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City | BOCA RATON
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State | FL
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Zip | 33433-6709
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Country | US
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Telephone | 954-552-9773
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Fax |
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Provider Business Mailing Address
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Address Line | 5640 PACIFIC BLVD APT 1035
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City | BOCA RATON
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State | FL
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Zip | 33433-6709
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | THERAPIST
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Name | BRANDON HARRIS
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Credential |
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Telephone | 954-552-9773
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | MH 11597
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License Number State | FL
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