Provider Demographics
NPI:1235899378
Name:HARRIS, JADE TRINITY
Entity Type:Individual
Prefix:
First Name:JADE
Middle Name:TRINITY
Last Name:HARRIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39159 PASEO PADRE PKWY STE 205
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94538-1623
Mailing Address - Country:US
Mailing Address - Phone:510-294-9525
Mailing Address - Fax:
Practice Address - Street 1:39159 PASEO PADRE PKWY STE 205
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94538-1623
Practice Address - Country:US
Practice Address - Phone:510-294-9525
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-29
Last Update Date:2021-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician