Provider Demographics
NPI:1982374765
Name:HARRIS, SHANICE B
Entity Type:Individual
Prefix:
First Name:SHANICE
Middle Name:B
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 1:5329 OFFICE CENTER CT STE 150
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93309-7403
Mailing Address - Country:US
Mailing Address - Phone:661-699-0558
Mailing Address - Fax:
Practice Address - Street 1:501 TAYLOR ST APT 42
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93309-3028
Practice Address - Country:US
Practice Address - Phone:661-567-9694
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-14
Last Update Date:2021-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician