Provider Demographics
NPI:1760001630
Name:HARRIS, ROBBION JARADO
Entity Type:Individual
Prefix:
First Name:ROBBION
Middle Name:JARADO
Last Name:HARRIS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4104 INGLESIDE DR SE
Mailing Address - Street 2:
Mailing Address - City:LACEY
Mailing Address - State:WA
Mailing Address - Zip Code:98503-2113
Mailing Address - Country:US
Mailing Address - Phone:253-426-9962
Mailing Address - Fax:
Practice Address - Street 1:4104 INGLESIDE DR SE
Practice Address - Street 2:
Practice Address - City:LACEY
Practice Address - State:WA
Practice Address - Zip Code:98503-2113
Practice Address - Country:US
Practice Address - Phone:253-426-9962
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-10
Last Update Date:2020-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA531617500Medicaid