Provider Demographics
NPI:1447998315
Name:HARRIS, JAKARI MARKELL
Entity type:Individual
Prefix:
First Name:JAKARI
Middle Name:MARKELL
Last Name:HARRIS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:114 RICHARDSON DR
Mailing Address - Street 2:
Mailing Address - City:VALLEJO
Mailing Address - State:CA
Mailing Address - Zip Code:94589-2451
Mailing Address - Country:US
Mailing Address - Phone:925-204-5859
Mailing Address - Fax:
Practice Address - Street 1:114 RICHARDSON DR
Practice Address - Street 2:
Practice Address - City:VALLEJO
Practice Address - State:CA
Practice Address - Zip Code:94589-2451
Practice Address - Country:US
Practice Address - Phone:925-204-5859
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-21
Last Update Date:2022-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1811547052103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst