Provider Demographics
NPI:1306335906
Name:HARRIS, MARILYN BRIANI (MED, BCBA, LBA)
Entity type:Individual
Prefix:
First Name:MARILYN
Middle Name:BRIANI
Last Name:HARRIS
Suffix:
Gender:F
Credentials:MED, BCBA, LBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:LAPEER
Mailing Address - State:MI
Mailing Address - Zip Code:48446-2825
Mailing Address - Country:US
Mailing Address - Phone:810-728-8142
Mailing Address - Fax:
Practice Address - Street 1:125 RIDGE DR
Practice Address - Street 2:
Practice Address - City:LAPEER
Practice Address - State:MI
Practice Address - Zip Code:48446-2825
Practice Address - Country:US
Practice Address - Phone:810-728-8142
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-09
Last Update Date:2023-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI7401000529103K00000X
103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst