Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 102L00000X | Psychologist | PY 2265 | FL |
N | 103T00000X | Psychologist | PY 2265 | FL |
Y | 103G00000X | Clinical Psychologist | PY 2265 | FL |
Y | 103TC0700X | Clinical Psychologist | PY 2265 | FL |
N | 103TC1900X | Counseling Psychologist | PY 2265 | FL |
NPI | 1093884892 |
---|---|
Provider Name | Dr. Michael A. Harrell |
First Address | Winter Park, FL 32789-3602 |
Second Address | Winter Park, FL 32789-3602 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/11/2006 |
Last Update Date | 06/01/2009 |