Provider Demographics
NPI:1720536717
Name:MELISSA HARRISON, LLC
Entity Type:Organization
Organization Name:MELISSA HARRISON, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:HARRISON
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:954-603-0077
Mailing Address - Street 1:11555 HERON BAY BLVD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33076-3360
Mailing Address - Country:US
Mailing Address - Phone:954-603-0077
Mailing Address - Fax:
Practice Address - Street 1:11555 HERON BAY BLVD
Practice Address - Street 2:SUITE 200
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33076-3360
Practice Address - Country:US
Practice Address - Phone:954-603-0077
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-19
Last Update Date:2016-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLE6091ZMedicare PIN