Doctor Name: | DR. MICHAEL RICHARD HARRISON |
NPI Number: | 1063563559 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | PH.D. |
License Number: | 00832 |
Business Practice Address: | 5 Westowne St Ste 501 Liberty, MO - 640683512 |
Business Phone Number: | 8167812110 |
Business Fax Number: | 8167812312 |
Mailing Address: | 5 Westowne St., Ste 501 LIBERTY |
State: | MO |
Postal Code: | 640683512 |
Phone Number: | 8167812110 |
Fax Number: | 8167812312 |
NPI Enumeration Date: | 01/13/2007 |
NPI Last Update Date: | 01/05/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 103TC0700X |
License Number: | 00832 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MO |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Psychologist |
Taxonomy Specialization: | Clinical |
Taxonomy Definition: |