1598927303 NPI number — MICHELLE HARVEY, PHD CLINICAL HEALTH PSYCHOLOGY

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1598927303 NPI number — MICHELLE HARVEY, PHD CLINICAL HEALTH PSYCHOLOGY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MICHELLE HARVEY, PHD CLINICAL HEALTH PSYCHOLOGY
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1598927303
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/12/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5751 KROGER DR
Provider Second Line Business Mailing Address:
SUITE 244
Provider Business Mailing Address City Name:
KELLER
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
76244-5649
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
817-805-1510
Provider Business Mailing Address Fax Number:
817-581-9939

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5751 KROGER DR
Provider Second Line Business Practice Location Address:
SUITE 224
Provider Business Practice Location Address City Name:
FORT WORTH
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
76244-5632
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
817-805-1510
Provider Business Practice Location Address Fax Number:
817-581-9939
Provider Enumeration Date:
07/02/2008

Additional Information

Authorized Official

Authorized Official Last Name:
HARVEY
Authorized Official First Name:
MICHELLE
Authorized Official Middle Name:
BETTE
Authorized Official Title or Position:
PARTNER
Authorized Official Telephone Number:
817-805-1510

Provider Taxonomy Codes

  • Taxonomy code: 261QH0100X , with the licence number:  32781 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 103TC0700X , with the licence number: 32781 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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