Provider Demographics
NPI:1588330369
Name:HARRIS, BRIAN J (BA, LSW, CAC, CBIS)
Entity type:Individual
Prefix:
First Name:BRIAN
Middle Name:J
Last Name:HARRIS
Suffix:
Gender:M
Credentials:BA, LSW, CAC, CBIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2848 CUMBERLAND RD
Mailing Address - Street 2:
Mailing Address - City:BERKLEY
Mailing Address - State:MI
Mailing Address - Zip Code:48072-1575
Mailing Address - Country:US
Mailing Address - Phone:248-709-6794
Mailing Address - Fax:
Practice Address - Street 1:2848 CUMBERLAND RD
Practice Address - Street 2:
Practice Address - City:BERKLEY
Practice Address - State:MI
Practice Address - Zip Code:48072-1575
Practice Address - Country:US
Practice Address - Phone:248-709-6794
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-20
Last Update Date:2021-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6802065712171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator