Provider Demographics
NPI:1376428904
Name:HARRIS, TY'ASIA
Entity type:Individual
Prefix:
First Name:TY'ASIA
Middle Name:
Last Name:HARRIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2295 RECREATION RD APT R4
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31217-4647
Mailing Address - Country:US
Mailing Address - Phone:478-738-1020
Mailing Address - Fax:
Practice Address - Street 1:2295 RECREATION RD APT R4
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31217-4647
Practice Address - Country:US
Practice Address - Phone:478-738-1020
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-11
Last Update Date:2025-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst