Provider Demographics
NPI:1821214453
Name:HARRISON, MICHELLE D (LMHC-LICENSED ME)
Entity Type:Individual
Prefix:MS
First Name:MICHELLE
Middle Name:D
Last Name:HARRISON
Suffix:
Gender:F
Credentials:LMHC-LICENSED ME
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1576 AIRPORT BLVD.
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32504-8661
Mailing Address - Country:US
Mailing Address - Phone:850-478-3888
Mailing Address - Fax:850-478-0914
Practice Address - Street 1:1576 AIRPORT BLVD.
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32504-8661
Practice Address - Country:US
Practice Address - Phone:850-436-6412
Practice Address - Fax:850-436-6414
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-18
Last Update Date:2012-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH6295101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health