Provider Demographics
NPI:1861718488
Name:MICHELLE HARVEY, PHD CLINICAL HEALTH PSYCHOLOGY, P.C.
Entity type:Organization
Organization Name:MICHELLE HARVEY, PHD CLINICAL HEALTH PSYCHOLOGY, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:BETTE
Authorized Official - Last Name:HARVEY
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:817-805-1510
Mailing Address - Street 1:8325 WHITLEY RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:WATAUGA
Mailing Address - State:TX
Mailing Address - Zip Code:76148-2487
Mailing Address - Country:US
Mailing Address - Phone:817-805-1510
Mailing Address - Fax:817-337-0986
Practice Address - Street 1:8325 WHITLEY RD
Practice Address - Street 2:SUITE 200
Practice Address - City:WATAUGA
Practice Address - State:TX
Practice Address - Zip Code:76148-2487
Practice Address - Country:US
Practice Address - Phone:817-805-1510
Practice Address - Fax:817-337-0986
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-08
Last Update Date:2012-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX32781103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXTXB107992Medicare PIN
8F9237Medicare PIN