Provider Demographics
NPI:1437285830
Name:HARBOR PSYCHOLOGICAL ASSOCIATES PC
Entity Type:Organization
Organization Name:HARBOR PSYCHOLOGICAL ASSOCIATES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST/CO-OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STELLA
Authorized Official - Middle Name:E
Authorized Official - Last Name:DIAL
Authorized Official - Suffix:
Authorized Official - Credentials:EDD
Authorized Official - Phone:231-726-2299
Mailing Address - Street 1:1148 4TH ST
Mailing Address - Street 2:
Mailing Address - City:MUSKEGON
Mailing Address - State:MI
Mailing Address - Zip Code:49441-1921
Mailing Address - Country:US
Mailing Address - Phone:231-726-2299
Mailing Address - Fax:231-728-6345
Practice Address - Street 1:1148 4TH ST
Practice Address - Street 2:
Practice Address - City:MUSKEGON
Practice Address - State:MI
Practice Address - Zip Code:49441-1921
Practice Address - Country:US
Practice Address - Phone:231-726-2299
Practice Address - Fax:231-728-6345
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-27
Last Update Date:2008-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounselingGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIP10F112290OtherLIMITED LICENSE PSYCHOLOG
MI680F110440OtherFULLY LICENESED PSYCHOLOGISTS
MI0P53690Medicare PIN