Provider Demographics
NPI:1376278242
Name:HARRIS, TAMIA TATYANNA
Entity Type:Individual
Prefix:
First Name:TAMIA
Middle Name:TATYANNA
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 1:16444 SANDY SHORE DR
Mailing Address - Street 2:
Mailing Address - City:WESTLAKE
Mailing Address - State:FL
Mailing Address - Zip Code:33470-7029
Mailing Address - Country:US
Mailing Address - Phone:561-713-5493
Mailing Address - Fax:
Practice Address - Street 1:5840 CORPORATE WAY STE 105
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33407-2040
Practice Address - Country:US
Practice Address - Phone:561-203-0714
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-23
Last Update Date:2022-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician