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General NPI Number Information
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NPI Number | 1508790080
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Entity Type | Individual
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Provider Name | HARRISON ANDERSON MAYES
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Gender | Male
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Dates
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Enumeration Date | 06/10/2026
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Last Update Date | 06/10/2026
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Provider Practice Location Address
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Address Line | 4943 N 29TH E STE B
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City | IDAHO FALLS
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State | ID
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Zip | 83401-1314
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Country | US
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Telephone | 307-257-5487
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Fax |
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Provider Business Mailing Address
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Address Line | 300 N 2ND W APT 3202
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City | REXBURG
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State | ID
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Zip | 83440-1206
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Country | US
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Telephone | 208-440-8519
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number | RBT-26-538485
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License Number State | ID
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