Provider Demographics
NPI:1013646462
Name:HARRIS, LANQUONE (RBT)
Entity Type:Individual
Prefix:
First Name:LANQUONE
Middle Name:
Last Name:HARRIS
Suffix:
Gender:M
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3491 GANDY BLVD N STE 101B
Mailing Address - Street 2:
Mailing Address - City:PINELLAS PARK
Mailing Address - State:FL
Mailing Address - Zip Code:33781-2652
Mailing Address - Country:US
Mailing Address - Phone:813-648-1162
Mailing Address - Fax:
Practice Address - Street 1:3491 GANDY BLVD N STE 101B
Practice Address - Street 2:
Practice Address - City:PINELLAS PARK
Practice Address - State:FL
Practice Address - Zip Code:33781-2652
Practice Address - Country:US
Practice Address - Phone:813-648-1162
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-09
Last Update Date:2023-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst