Provider Demographics
NPI:1134200959
Name:HARRIS, MICHAEL EARL (PHD)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:EARL
Last Name:HARRIS
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9200 COLIMA RD
Mailing Address - Street 2:#206
Mailing Address - City:WHITTIER
Mailing Address - State:CA
Mailing Address - Zip Code:90605-1814
Mailing Address - Country:US
Mailing Address - Phone:562-945-5454
Mailing Address - Fax:562-693-1184
Practice Address - Street 1:9200 COLIMA RD
Practice Address - Street 2:#206
Practice Address - City:WHITTIER
Practice Address - State:CA
Practice Address - Zip Code:90605-1814
Practice Address - Country:US
Practice Address - Phone:562-945-5454
Practice Address - Fax:562-693-1184
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-18
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY6253103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACP6253Medicare ID - Type UnspecifiedMEDICARE PROVIDER ID
CAR61991Medicare UPIN