Provider Demographics
NPI:1174014187
Name:HARRIS, REBECCA RACHELE
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:RACHELE
Last Name:HARRIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:REBECCA
Other - Middle Name:RACHELE
Other - Last Name:LYNN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:16941 N EAGLE RIVER LOOP RD
Mailing Address - Street 2:
Mailing Address - City:EAGLE RIVER
Mailing Address - State:AK
Mailing Address - Zip Code:99577-7824
Mailing Address - Country:US
Mailing Address - Phone:907-726-5330
Mailing Address - Fax:907-726-5366
Practice Address - Street 1:16941 N EAGLE RIVER LOOP RD
Practice Address - Street 2:
Practice Address - City:EAGLE RIVER
Practice Address - State:AK
Practice Address - Zip Code:99577-7824
Practice Address - Country:US
Practice Address - Phone:907-726-5330
Practice Address - Fax:907-726-5366
Is Sole Proprietor?:No
Enumeration Date:2018-05-24
Last Update Date:2020-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK106S00000X
AK167814103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician