Healthcare Provider Details

I. General information

NPI: 1922553262
Provider Name (Legal Business Name): MICHELLE HARRISON LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/16/2016
Last Update Date: 11/10/2022
Certification Date: 11/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6507 SUMMER COVE DR
RIVERVIEW FL
33578-8947
US

IV. Provider business mailing address

6507 SUMMER COVE DR
RIVERVIEW FL
33578-8947
US

V. Phone/Fax

Practice location:
  • Phone: 959-888-1718
  • Fax:
Mailing address:
  • Phone: 959-888-1718
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: