Provider Demographics
NPI:1063760148
Name:HARRISON, CHANIKA JANEL (OUTPATIENT THERAPIST)
Entity type:Individual
Prefix:
First Name:CHANIKA
Middle Name:JANEL
Last Name:HARRISON
Suffix:
Gender:F
Credentials:OUTPATIENT THERAPIST
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Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:2505 NORTHWEST 82ND STREET, LAWTON, OK, USA
Mailing Address - Street 2:A6
Mailing Address - City:LAWTON
Mailing Address - State:OK
Mailing Address - Zip Code:73505-2260
Mailing Address - Country:US
Mailing Address - Phone:405-593-8638
Mailing Address - Fax:
Practice Address - Street 1:2505 NORTHWEST 82ND STREET, LAWTON, OK, USA
Practice Address - Street 2:A6
Practice Address - City:LAWTON
Practice Address - State:OK
Practice Address - Zip Code:73505-2260
Practice Address - Country:US
Practice Address - Phone:405-593-8638
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-21
Last Update Date:2023-04-20
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst