Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 103G00000X | Clinical Psychologist | 5080 | MN |
N | 103TC0700X | Clinical Psychologist | 5080 | MN |
N | 103G00000X | Clinical Psychologist | 5080 | MN |
N | 103TC0700X | Clinical Psychologist | 5080 | MN |
Y | 103TR0400X | Rehabilitation Psychologist | 5080 | MN |
NPI | 1407847338 |
---|---|
Provider Name | Dr. Michael Harvey |
First Address | Colorado Springs, CO 80908-4814 |
Second Address | Fort Carson, CO 80913-4613 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/10/2005 |
Last Update Date | 18/09/2013 |