Healthcare Provider Details

I. General information

NPI: 1881149623
Provider Name (Legal Business Name): MR. MICHAEL HARVEY SR.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/22/2016
Last Update Date: 05/29/2025
Certification Date: 05/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2501 W EL SEGUNDO BLVD # A
HAWTHORNE CA
90250-3317
US

IV. Provider business mailing address

15519 CRENSHAW BLVD
GARDENA CA
90249-4525
US

V. Phone/Fax

Practice location:
  • Phone: 323-754-2816
  • Fax: 323-754-2816
Mailing address:
  • Phone: 310-679-9126
  • Fax: 310-679-2920

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number9378
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: