Provider Demographics
NPI:1902397474
Name:HARRIS, LEIGH COURTNEY (BCBA)
Entity Type:Individual
Prefix:
First Name:LEIGH
Middle Name:COURTNEY
Last Name:HARRIS
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:96 WOODLANDS PL
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:GA
Mailing Address - Zip Code:30132-3118
Mailing Address - Country:US
Mailing Address - Phone:708-415-2639
Mailing Address - Fax:
Practice Address - Street 1:96 WOODLANDS PL
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:GA
Practice Address - Zip Code:30132-3118
Practice Address - Country:US
Practice Address - Phone:708-415-2639
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-21
Last Update Date:2022-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL17-38024106S00000X
GA1-19-37104103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician