Provider Demographics
NPI:1134636327
Name:MICHELLE HARRIMAN PSYCHOLOGIST A PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:MICHELLE HARRIMAN PSYCHOLOGIST A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:HARRIMAN
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:818-269-7224
Mailing Address - Street 1:1440 N HARBOR BLVD STE 900
Mailing Address - Street 2:
Mailing Address - City:FULLERTON
Mailing Address - State:CA
Mailing Address - Zip Code:92835-4122
Mailing Address - Country:US
Mailing Address - Phone:818-269-7224
Mailing Address - Fax:772-679-2402
Practice Address - Street 1:1440 N HARBOR BLVD STE 808
Practice Address - Street 2:
Practice Address - City:FULLERTON
Practice Address - State:CA
Practice Address - Zip Code:92835
Practice Address - Country:US
Practice Address - Phone:818-269-7224
Practice Address - Fax:772-679-2402
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-09
Last Update Date:2023-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY19763103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty