Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TC2200X | Clinical Child & Adolescent Psychologist | 01648 | MO |
NPI | 1033243134 |
---|---|
Provider Name | Dr. Michael Avram Harris |
First Address | Portland, OR 97219-1175 |
Second Address | Portland, OR 97239-2901 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/03/2007 |
Last Update Date | 08/07/2007 |