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General NPI Number Information
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NPI Number | 1639160336
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Entity Type | Individual
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Provider Name | THERESA LYNNE HARPOLD MD
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Gender | Female
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Dates
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Enumeration Date | 11/02/2005
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Last Update Date | 03/11/2025
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Provider Practice Location Address
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Address Line | 6900 E 10 MILE RD
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City | CENTER LINE
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State | MI
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Zip | 48015-1168
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Country | US
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Telephone | 586-501-3070
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Fax | 248-386-5176
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Provider Business Mailing Address
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Address Line | 4065 E HILLS CT SE
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City | GRAND RAPIDS
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State | MI
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Zip | 49546-6299
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Country | US
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Telephone | 616-942-2081
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 205023
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License Number State | MA
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