Provider Demographics
NPI:1972230050
Name:HARRIS, KATIE
Entity Type:Individual
Prefix:
First Name:KATIE
Middle Name:
Last Name:HARRIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14144 W BATTENBERG CT
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83713-1241
Mailing Address - Country:US
Mailing Address - Phone:208-519-2475
Mailing Address - Fax:
Practice Address - Street 1:1905 S TOPAZ WAY # 100
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83642-4477
Practice Address - Country:US
Practice Address - Phone:208-518-0870
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-08
Last Update Date:2022-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician