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NPI Code Detail

MEDICARE: MICHAEL L. HARRIS M.A., L.P.

MEDICARE: MICHAEL L. HARRIS M.A., L.P.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103TC0700XClinical PsychologistLP3629MN

General Provider Information

NPI Number : 1457312225
Entity Type Code : Individual
Provider Name (Legal Business Name) : MICHAEL L. HARRIS M.A., L.P.
Provider Business Mailing Address
First Line : 1315 E 24TH ST
Second Line :
City : MINNEAPOLIS
State : MN
Zip : 55404-3975
Country : US
Telephone Number : 612-721-9868
Fax Number : 612-721-9850
Provider Business Practice Location Address
First Line : 1315 E 24TH ST
Second Line :
City : MINNEAPOLIS
State : MN
Zip : 55404-3975
Country : US
Telephone Number : 612-721-9868
Fax Number : 612-721-9850
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/31/2006
Last Update Date : 07/08/2007

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