Provider Demographics
NPI:1730410598
Name:HARRISON, MIRIAM KAY (LMHC)
Entity type:Individual
Prefix:
First Name:MIRIAM
Middle Name:KAY
Last Name:HARRISON
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7550 SW 57TH AVE STE 206
Mailing Address - Street 2:
Mailing Address - City:SOUTH MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33143-5336
Mailing Address - Country:US
Mailing Address - Phone:305-519-2827
Mailing Address - Fax:
Practice Address - Street 1:7550 SW 57TH AVE STE 206
Practice Address - Street 2:
Practice Address - City:SOUTH MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33143-5336
Practice Address - Country:US
Practice Address - Phone:305-519-2827
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-01-19
Last Update Date:2019-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL5271101YA0400X
FLMH10079101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL001789000Medicaid