1194875005 NPI number — MR. JOSEPH RICHARD HARRISON

Table of content: MR. JOSEPH RICHARD HARRISON (NPI 1194875005)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1194875005 NPI number — MR. JOSEPH RICHARD HARRISON

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HARRISON
Provider First Name:
JOSEPH
Provider Middle Name:
RICHARD
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1194875005
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/04/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1680 FELKINS STREET, EMBEDDED BEHAVIORAL HEALTH TEAM 5
Provider Second Line Business Mailing Address:
BLDG. 1226
Provider Business Mailing Address City Name:
COLORADO SPRINGS
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80913
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
719-503-7709
Provider Business Mailing Address Fax Number:
719-526-8770

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1680 FELKINS STREET, EMBEDDED BEHAVIORAL HEALTH TEAM 5
Provider Second Line Business Practice Location Address:
BLDG. 1226
Provider Business Practice Location Address City Name:
COLORADO SPRINGS
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80913
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
719-503-7709
Provider Business Practice Location Address Fax Number:
719-526-8770
Provider Enumeration Date:
01/11/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 164W00000X , with the licence number:  30122 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)