Provider Demographics
NPI:1639634967
Name:HARRISON, BRIAN DANIEL (LLMSW)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:DANIEL
Last Name:HARRISON
Suffix:
Gender:M
Credentials:LLMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5380 HOLIDAY TER STE 28
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49009-2128
Mailing Address - Country:US
Mailing Address - Phone:269-409-3000
Mailing Address - Fax:
Practice Address - Street 1:5380 HOLIDAY TER
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49009-2154
Practice Address - Country:US
Practice Address - Phone:269-409-3000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-31
Last Update Date:2021-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL34673101YA0400X
IL150.103338104100000X
MI68511068431041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No104100000XBehavioral Health & Social Service ProvidersSocial Worker