Provider Demographics
NPI:1447473038
Name:HARRISON, MICHAEL DEWITT (PHD)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:DEWITT
Last Name:HARRISON
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 7353
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77248-7353
Mailing Address - Country:US
Mailing Address - Phone:713-504-7772
Mailing Address - Fax:832-209-7290
Practice Address - Street 1:1501 CROCKER ST
Practice Address - Street 2:SUITE 1
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77019-4340
Practice Address - Country:US
Practice Address - Phone:713-504-7772
Practice Address - Fax:832-209-7290
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-11
Last Update Date:2022-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX33283103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX2161010-01Medicaid
TX613691Medicare PIN