Basic Information
| Provider Information | |||||||||
| NPI: | 1932280047 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HARRISON | ||||||||
| FirstName: | JAMES | ||||||||
| MiddleName: | MILNER | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | M.A. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1709 MCKINLEY ST | ||||||||
| Address2: | |||||||||
| City: | WYANDOTTE | ||||||||
| State: | MI | ||||||||
| PostalCode: | 481927206 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7342823518 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 20600 EUREKA RD | ||||||||
| Address2: | SUITE 819 | ||||||||
| City: | TAYLOR | ||||||||
| State: | MI | ||||||||
| PostalCode: | 481805343 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7342858282 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/17/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103TC0700X | 6301009008 | MI | Y | Behavioral Health & Social Service Providers | Psychologist | Clinical |
No ID Information.