Healthcare Provider Details

I. General information

NPI: 1932280047
Provider Name (Legal Business Name): JAMES MILNER HARRISON M.A.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/17/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20600 EUREKA RD SUITE 819
TAYLOR MI
48180-5343
US

IV. Provider business mailing address

1709 MCKINLEY ST
WYANDOTTE MI
48192-7206
US

V. Phone/Fax

Practice location:
  • Phone: 734-285-8282
  • Fax:
Mailing address:
  • Phone: 734-282-3518
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number6301009008
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: