Provider Demographics
NPI:1992188445
Name:HARRISON, NATASHA LAUREN
Entity Type:Individual
Prefix:
First Name:NATASHA
Middle Name:LAUREN
Last Name:HARRISON
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:PO BOX 1432
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97709-1432
Mailing Address - Country:US
Mailing Address - Phone:541-306-3483
Mailing Address - Fax:541-639-8909
Practice Address - Street 1:593 NE AZURE DR STE 4
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97701-4883
Practice Address - Country:US
Practice Address - Phone:541-306-3483
Practice Address - Fax:541-639-8909
Is Sole Proprietor?:No
Enumeration Date:2015-07-01
Last Update Date:2015-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1942537444103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst