Provider Demographics
NPI:1275408650
Name:HARRIS, JUSTYN CHASE
Entity type:Individual
Prefix:
First Name:JUSTYN
Middle Name:CHASE
Last Name:HARRIS
Suffix:
Gender:X
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4739 UNIVERSITY WAY NE # 2032
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98105-4412
Mailing Address - Country:US
Mailing Address - Phone:888-425-4605
Mailing Address - Fax:
Practice Address - Street 1:4739 UNIVERSITY WAY NE # 2032
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98105-4412
Practice Address - Country:US
Practice Address - Phone:888-425-4605
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-10-07
Last Update Date:2025-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN000-2392175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist