Provider Demographics
NPI:1568928844
Name:HARRIS, SHANEL DAVINE
Entity Type:Individual
Prefix:
First Name:SHANEL
Middle Name:DAVINE
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 1:2983 TISBURY DR UNIT D
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89052-4356
Mailing Address - Country:US
Mailing Address - Phone:213-200-6123
Mailing Address - Fax:
Practice Address - Street 1:2755 E DESERT INN RD STE 160
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89121-3690
Practice Address - Country:US
Practice Address - Phone:702-538-8420
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-12
Last Update Date:2019-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician