Provider Demographics
NPI:1356460117
Name:HARRIS, MICHAEL LANE (MA)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:LANE
Last Name:HARRIS
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 181244
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80218-8825
Mailing Address - Country:US
Mailing Address - Phone:303-246-7135
Mailing Address - Fax:
Practice Address - Street 1:2818 13TH ST
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80304-3518
Practice Address - Country:US
Practice Address - Phone:303-246-7135
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health