Provider Demographics
NPI:1972234631
Name:HARRIS, PERRY RICHARD JR
Entity Type:Individual
Prefix:MR
First Name:PERRY
Middle Name:RICHARD
Last Name:HARRIS
Suffix:JR
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 1:2831 SAINT ROSE PKWY STE 237
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89052-4840
Mailing Address - Country:US
Mailing Address - Phone:702-589-4712
Mailing Address - Fax:
Practice Address - Street 1:2831 SAINT ROSE PKWY STE 237
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89052-4840
Practice Address - Country:US
Practice Address - Phone:702-589-4712
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-22
Last Update Date:2022-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVRBT2637106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician