Provider Demographics
NPI:1942240593
Name:HARVEY, MICHELLE BETTE (PHD)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:BETTE
Last Name:HARVEY
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:BETTE
Other - Last Name:JAQUETTE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5751 KROGER DR
Mailing Address - Street 2:SUITE 244
Mailing Address - City:KELLER
Mailing Address - State:TX
Mailing Address - Zip Code:76248-5532
Mailing Address - Country:US
Mailing Address - Phone:817-805-1510
Mailing Address - Fax:817-337-0986
Practice Address - Street 1:5751 KROGER DR
Practice Address - Street 2:SUITE 244
Practice Address - City:KELLER
Practice Address - State:TX
Practice Address - Zip Code:76248-5532
Practice Address - Country:US
Practice Address - Phone:817-805-1510
Practice Address - Fax:817-337-0986
Is Sole Proprietor?:No
Enumeration Date:2006-06-08
Last Update Date:2010-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX32781103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXTXB107993Medicare PIN
TX8F9237Medicare PIN