Provider Demographics
NPI:1679984132
Name:HARRELL, SEAN W (PSYD, MA)
Entity Type:Individual
Prefix:DR
First Name:SEAN
Middle Name:W
Last Name:HARRELL
Suffix:
Gender:M
Credentials:PSYD, MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:89 S VALLEY DR APT 22
Mailing Address - Street 2:
Mailing Address - City:EVANSTON
Mailing Address - State:WY
Mailing Address - Zip Code:82930-4887
Mailing Address - Country:US
Mailing Address - Phone:630-765-2345
Mailing Address - Fax:
Practice Address - Street 1:89 S VALLEY DR APT 22
Practice Address - Street 2:
Practice Address - City:EVANSTON
Practice Address - State:WY
Practice Address - Zip Code:82930-4887
Practice Address - Country:US
Practice Address - Phone:630-765-2345
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-17
Last Update Date:2014-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist