Provider Demographics
NPI:1588295299
Name:HARRIS, TAYLOR (RBT)
Entity type:Individual
Prefix:
First Name:TAYLOR
Middle Name:
Last Name:HARRIS
Suffix:
Gender:M
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1210 PALM ST APT A
Mailing Address - Street 2:
Mailing Address - City:ABILENE
Mailing Address - State:TX
Mailing Address - Zip Code:79602-3600
Mailing Address - Country:US
Mailing Address - Phone:469-565-6230
Mailing Address - Fax:
Practice Address - Street 1:4606 S 14TH ST
Practice Address - Street 2:
Practice Address - City:ABILENE
Practice Address - State:TX
Practice Address - Zip Code:79605-4735
Practice Address - Country:US
Practice Address - Phone:325-307-7022
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-31
Last Update Date:2020-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXRBT-19-108609106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician