Provider Demographics
NPI:1841947736
Name:HARLEY, CHRISTOPHER
Entity type:Individual
Prefix:MR
First Name:CHRISTOPHER
Middle Name:
Last Name:HARLEY
Suffix:
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 1:1448 AVON LN APT 34
Mailing Address - Street 2:
Mailing Address - City:N LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33068-5879
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1448 AVON LN APT 34
Practice Address - Street 2:
Practice Address - City:N LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33068-5879
Practice Address - Country:US
Practice Address - Phone:954-624-6667
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-09
Last Update Date:2022-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL702922106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician