Basic Information
Provider Information
NPI: 1821106675
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: HARSHMAN
FirstName: WILLIAM
MiddleName: LESLIE
NamePrefix: DR.
NameSuffix:  
Credential: PH.D, LMSW, LLP, CAC
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 10785 S SAGINAW ST
Address2: BUILDING E
City: GRAND BLANC
State: MI
PostalCode: 484397003
CountryCode: US
TelephoneNumber: 8106950055
FaxNumber: 8106956813
Practice Location
Address1: 10785 S SAGINAW ST
Address2: BUILDING E
City: GRAND BLANC
State: MI
PostalCode: 484397003
CountryCode: US
TelephoneNumber: 8106950055
FaxNumber: 8106956813
Other Information
ProviderEnumerationDate: 08/29/2006
LastUpdateDate: 07/08/2007
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
101YP2500X6401007572MIX Behavioral Health & Social Service ProvidersCounselorProfessional
103TC0700X6301007032MIX Behavioral Health & Social Service ProvidersPsychologistClinical
1041C0700X6801066034MIX Behavioral Health & Social Service ProvidersSocial WorkerClinical

No ID Information.


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