=====================================================
General NPI Number Information
=====================================================
NPI Number | 1205259124
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | AULESHA HARRIS
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/29/2014
-----------------------------------------------------
Last Update Date | 08/28/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 18190 RAMSGATE DR
-----------------------------------------------------
City | LATHRUP VILLAGE
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48076-4522
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 248-200-7052
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 18190 RAMSGATE DR
-----------------------------------------------------
City | LATHRUP VILLAGE
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48076-4522
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 248-275-7281
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103TC0700X
-----------------------------------------------------
Taxonomy Name | Clinical Psychologist
-----------------------------------------------------
License Number | 6301012765
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------