Provider Demographics
NPI:1083392518
Name:KRISTIN NICOLE HARRIS LLC
Entity Type:Organization
Organization Name:KRISTIN NICOLE HARRIS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BEHAVIOR ANALYST FOUNDER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KRISTIN
Authorized Official - Middle Name:NICOLE
Authorized Official - Last Name:HARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA
Authorized Official - Phone:301-758-2817
Mailing Address - Street 1:1415 5TH PL
Mailing Address - Street 2:
Mailing Address - City:VERO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32962-2133
Mailing Address - Country:US
Mailing Address - Phone:301-758-2817
Mailing Address - Fax:
Practice Address - Street 1:1415 5TH PL
Practice Address - Street 2:
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32962-2133
Practice Address - Country:US
Practice Address - Phone:301-758-2817
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-05
Last Update Date:2023-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty