Provider Demographics
NPI:1194875005
Name:HARRISON, JOSEPH RICHARD
Entity type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:RICHARD
Last Name:HARRISON
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 1:1680 FELKINS STREET, EMBEDDED BEHAVIORAL HEALTH TEAM 5
Mailing Address - Street 2:BLDG. 1226
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80913
Mailing Address - Country:US
Mailing Address - Phone:719-503-7709
Mailing Address - Fax:719-526-8770
Practice Address - Street 1:1680 FELKINS STREET, EMBEDDED BEHAVIORAL HEALTH TEAM 5
Practice Address - Street 2:BLDG. 1226
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80913
Practice Address - Country:US
Practice Address - Phone:719-503-7709
Practice Address - Fax:719-526-8770
Is Sole Proprietor?:No
Enumeration Date:2007-01-11
Last Update Date:2021-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO30122164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse