Provider Demographics
NPI:1598927303
Name:MICHELLE HARVEY, PHD CLINICAL HEALTH PSYCHOLOGY
Entity Type:Organization
Organization Name:MICHELLE HARVEY, PHD CLINICAL HEALTH PSYCHOLOGY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:BETTE
Authorized Official - Last Name:HARVEY
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:817-805-1510
Mailing Address - Street 1:5751 KROGER DR
Mailing Address - Street 2:SUITE 244
Mailing Address - City:KELLER
Mailing Address - State:TX
Mailing Address - Zip Code:76244-5649
Mailing Address - Country:US
Mailing Address - Phone:817-805-1510
Mailing Address - Fax:817-581-9939
Practice Address - Street 1:5751 KROGER DR
Practice Address - Street 2:SUITE 224
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76244-5632
Practice Address - Country:US
Practice Address - Phone:817-805-1510
Practice Address - Fax:817-581-9939
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-02
Last Update Date:2009-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX32781103TC0700X, 261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
No261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth ServiceGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00Z873Medicare PIN