Provider Demographics
NPI:1619563095
Name:HARRIS, TRACEY (BCBA)
Entity Type:Individual
Prefix:
First Name:TRACEY
Middle Name:
Last Name:HARRIS
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:TRACEY
Other - Middle Name:
Other - Last Name:JONES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2177 S MCQUEEN RD APT 3077
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85286-1852
Mailing Address - Country:US
Mailing Address - Phone:480-645-1255
Mailing Address - Fax:
Practice Address - Street 1:5656 S POWER RD # 115
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85295-8487
Practice Address - Country:US
Practice Address - Phone:480-389-4516
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-18
Last Update Date:2020-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst