Provider Demographics
NPI:1356233092
Name:HARRISON, TASIA SHAUNTE (RBT)
Entity type:Individual
Prefix:
First Name:TASIA
Middle Name:SHAUNTE
Last Name:HARRISON
Suffix:
Gender:X
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7228 CIRCLE AVE
Mailing Address - Street 2:
Mailing Address - City:FOREST PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60130-1163
Mailing Address - Country:US
Mailing Address - Phone:630-632-4350
Mailing Address - Fax:
Practice Address - Street 1:7228 CIRCLE AVE
Practice Address - Street 2:
Practice Address - City:FOREST PARK
Practice Address - State:IL
Practice Address - Zip Code:60130-1163
Practice Address - Country:US
Practice Address - Phone:630-632-4350
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-17
Last Update Date:2025-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ILRBT-24-401487106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician