Provider Demographics
NPI:1881149623
Name:HARVEY, MICHAEL SR
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:
Last Name:HARVEY
Suffix:SR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15519 CRENSHAW BLVD
Mailing Address - Street 2:
Mailing Address - City:GARDENA
Mailing Address - State:CA
Mailing Address - Zip Code:90249-4525
Mailing Address - Country:US
Mailing Address - Phone:310-679-9126
Mailing Address - Fax:310-679-2920
Practice Address - Street 1:2501 W EL SEGUNDO BLVD # A
Practice Address - Street 2:
Practice Address - City:HAWTHORNE
Practice Address - State:CA
Practice Address - Zip Code:90250-3317
Practice Address - Country:US
Practice Address - Phone:323-754-2816
Practice Address - Fax:323-754-2816
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-22
Last Update Date:2025-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA9378101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)