Provider Demographics
NPI:1982936233
Name:HARVEY, BERNICE ELAINE (TLLP)
Entity Type:Individual
Prefix:
First Name:BERNICE
Middle Name:ELAINE
Last Name:HARVEY
Suffix:
Gender:F
Credentials:TLLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2922 RIVERSIDE DR
Mailing Address - Street 2:
Mailing Address - City:ORION TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48359-1593
Mailing Address - Country:US
Mailing Address - Phone:248-747-0738
Mailing Address - Fax:
Practice Address - Street 1:2922 RIVERSIDE DR
Practice Address - Street 2:
Practice Address - City:LAKE ORION
Practice Address - State:MI
Practice Address - Zip Code:48359-1593
Practice Address - Country:US
Practice Address - Phone:248-747-0738
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-10
Last Update Date:2015-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301012116103T00000X, 103TF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TF0000XBehavioral Health & Social Service ProvidersPsychologistFamily