Provider Demographics
NPI:1588799167
Name:HARRIMAN, MICHELLE (PSYD)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:HARRIMAN
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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 900
Practice Address - Street 2:
Practice Address - City:FULLERTON
Practice Address - State:CA
Practice Address - Zip Code:92835-4122
Practice Address - Country:US
Practice Address - Phone:818-269-7224
Practice Address - Fax:772-679-2402
Is Sole Proprietor?:No
Enumeration Date:2007-02-22
Last Update Date:2020-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY19763103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical