MEDICARE: MICHELLE HARVEY, PHD CLINICAL HEALTH PSYCHOLOGY

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
1	261QH0100X	Health Service Clinic/Center	32781	TX
2	103TC0700X	Clinical Psychologist	32781	TX

General Provider Information

NPI Number	:	1598927303
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MICHELLE HARVEY, PHD CLINICAL HEALTH PSYCHOLOGY

Provider Business Mailing Address
First Line	:	5751 KROGER DR
Second Line	:	SUITE 244
City	:	KELLER
State	:	TX
Zip	:	76244-5649
Country	:	US
Telephone Number	:	817-805-1510
Fax Number	:	817-581-9939

Provider Business Practice Location Address
First Line	:	5751 KROGER DR
Second Line	:	SUITE 224
City	:	FORT WORTH
State	:	TX
Zip	:	76244-5632
Country	:	US
Telephone Number	:	817-805-1510
Fax Number	:	817-581-9939

Authorized Official
Title or Position	:	PARTNER
Name	:	DR. MICHELLE BETTE HARVEY
Credential	:	PHD
Telephone Number	:	817-805-1510

Provider Enumeration Date	:	07/02/2008
Last Update Date	:	10/12/2009

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