Provider Demographics
NPI:1679009112
Name:HARBISON, AMY L (PHD, BCBA, LBA)
Entity Type:Individual
Prefix:DR
First Name:AMY
Middle Name:L
Last Name:HARBISON
Suffix:
Gender:F
Credentials:PHD, BCBA, LBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3837 S 12TH ST
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98405-2138
Mailing Address - Country:US
Mailing Address - Phone:833-971-1230
Mailing Address - Fax:253-393-2338
Practice Address - Street 1:3837 S 12TH ST
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98405-2138
Practice Address - Country:US
Practice Address - Phone:833-971-1230
Practice Address - Fax:253-393-2338
Is Sole Proprietor?:No
Enumeration Date:2017-05-03
Last Update Date:2023-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2106527Medicaid