MEDICARE: DR. SEAN W. HARRELL PSY.D, M.A.

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	103T00000X	Psychologist

General Provider Information

NPI Number	:	1679984132
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SEAN W. HARRELL PSY.D, M.A.

Provider Business Mailing Address
First Line	:	89 S VALLEY DR APT 22
Second Line	:
City	:	EVANSTON
State	:	WY
Zip	:	82930-4887
Country	:	US
Telephone Number	:	630-765-2345
Fax Number	:

Provider Business Practice Location Address
First Line	:	89 S VALLEY DR APT 22
Second Line	:
City	:	EVANSTON
State	:	WY
Zip	:	82930-4887
Country	:	US
Telephone Number	:	630-765-2345
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/17/2014
Last Update Date	:	05/17/2014

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