Provider Demographics
NPI:1669480091
Name:HARRIS, AARON A (PHD)
Entity Type:Individual
Prefix:DR
First Name:AARON
Middle Name:A
Last Name:HARRIS
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3670 S 25TH E STE 2
Mailing Address - Street 2:
Mailing Address - City:IDAHO FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83404-4956
Mailing Address - Country:US
Mailing Address - Phone:208-522-3404
Mailing Address - Fax:208-524-1093
Practice Address - Street 1:3522 BRIAR CREEK LN
Practice Address - Street 2:
Practice Address - City:AMMON
Practice Address - State:ID
Practice Address - Zip Code:83406-4728
Practice Address - Country:US
Practice Address - Phone:208-529-1680
Practice Address - Fax:208-529-1699
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-03
Last Update Date:2021-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS2171103TC0700X
IDPSY-203086103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical