Provider Demographics
NPI:1205062536
Name:HARRISON, TIAMARIE JENELLE
Entity type:Individual
Prefix:
First Name:TIAMARIE
Middle Name:JENELLE
Last Name:HARRISON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:TIA
Other - Middle Name:
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MS ED/SPED CHHC
Mailing Address - Street 1:6060 BUCKINGHAM PKWY
Mailing Address - Street 2:APT 317
Mailing Address - City:CULVER CITY
Mailing Address - State:CA
Mailing Address - Zip Code:90230-6856
Mailing Address - Country:US
Mailing Address - Phone:310-902-5046
Mailing Address - Fax:
Practice Address - Street 1:6060 BUCKINGHAM PKWY
Practice Address - Street 2:APT 317
Practice Address - City:CULVER CITY
Practice Address - State:CA
Practice Address - Zip Code:90230-6856
Practice Address - Country:US
Practice Address - Phone:310-902-5046
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-01
Last Update Date:2014-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst