Provider Demographics
NPI:1710764014
Name:HARRIS, DJUNA M
Entity Type:Individual
Prefix:
First Name:DJUNA
Middle Name:M
Last Name:HARRIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:NYKIA
Other - Middle Name:D
Other - Last Name:GATSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:4721 N BAJA CT
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67204-2363
Mailing Address - Country:US
Mailing Address - Phone:316-207-2232
Mailing Address - Fax:
Practice Address - Street 1:4721 N BAJA CT
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67204-2363
Practice Address - Country:US
Practice Address - Phone:316-207-2232
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-11
Last Update Date:2023-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No347C00000XTransportation ServicesPrivate Vehicle