Provider Demographics
NPI:1760137996
Name:HARRIS, STEPHANIE (PMHNP)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:
Last Name:HARRIS
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:36500 FORD RD # 319
Mailing Address - Street 2:
Mailing Address - City:WESTLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48185-3769
Mailing Address - Country:US
Mailing Address - Phone:734-674-5677
Mailing Address - Fax:
Practice Address - Street 1:130 MEDICAL CENTER DR
Practice Address - Street 2:
Practice Address - City:CARLETON
Practice Address - State:MI
Practice Address - Zip Code:48117-9461
Practice Address - Country:US
Practice Address - Phone:734-654-2169
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-16
Last Update Date:2022-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704304359363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health