Provider Demographics
NPI:1992387179
Name:MARY H HARRELL PSYCHOLOGIST, PLLC
Entity Type:Organization
Organization Name:MARY H HARRELL PSYCHOLOGIST, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORGANIZER/MEMPER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARY
Authorized Official - Middle Name:H
Authorized Official - Last Name:HARRELL
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:315-529-1013
Mailing Address - Street 1:1031 GREGORY JON CT
Mailing Address - Street 2:
Mailing Address - City:FORT MILL
Mailing Address - State:SC
Mailing Address - Zip Code:29707-0091
Mailing Address - Country:US
Mailing Address - Phone:315-529-1013
Mailing Address - Fax:
Practice Address - Street 1:15720 BRIXHAM HILL AVE STE 300
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28277-4784
Practice Address - Country:US
Practice Address - Phone:803-802-7143
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-27
Last Update Date:2021-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty