Provider Demographics
NPI:1710309612
Name:HARRISON, MICHELLE
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:HARRISON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4545 N 67TH AVE
Mailing Address - Street 2:UNIT 1114
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85033-1660
Mailing Address - Country:US
Mailing Address - Phone:602-616-5014
Mailing Address - Fax:
Practice Address - Street 1:4545 N 67TH AVE
Practice Address - Street 2:UNIT 1114
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85033-1660
Practice Address - Country:US
Practice Address - Phone:602-616-5014
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-10
Last Update Date:2014-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker