Basic Information
| Provider Information | |||||||||
| NPI: | 1841403813 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HARVEY | ||||||||
| FirstName: | MICHELLE | ||||||||
| MiddleName: | VERA | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | M.A., L.M.F.T. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4880 MARKET ST | ||||||||
| Address2: | |||||||||
| City: | VENTURA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 930037783 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3103377827 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 6101 W CENTINELA AVE | ||||||||
| Address2: | SUITE 380 | ||||||||
| City: | CULVER CITY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 902306337 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3103377827 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/07/2007 | ||||||||
| LastUpdateDate: | 01/27/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106H00000X | 49645 | CA | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.