Provider Demographics
NPI:1114544251
Name:HARRIS, DORIAN
Entity Type:Individual
Prefix:
First Name:DORIAN
Middle Name:
Last Name:HARRIS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 MOUNTAIN VIEW DR APT C102
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NM
Mailing Address - Zip Code:87701-4759
Mailing Address - Country:US
Mailing Address - Phone:213-819-9325
Mailing Address - Fax:
Practice Address - Street 1:200 MOUNTAIN VIEW DR APT C102
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NM
Practice Address - Zip Code:87701-4759
Practice Address - Country:US
Practice Address - Phone:213-819-9325
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-04
Last Update Date:2020-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician