Individual provider Active NPI

Michael Richard Harrison, PH.D.

  • Clinical Psychologist
  • Liberty, MO
National Provider Identifier
1063563559
Registry record updated Jan 5, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
00832 Issued in MO
Practice address
5 Westowne St
Ste 501
Liberty, MO 64068-3512
Phone
(816) 781-2110
Fax
(816) 781-2312
NPI assigned
Jan 13, 2007
Last updated
Jan 5, 2012By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 5, 2012

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Psychologist 103TC0700X 00832 MO Primary

Addresses

Primary practice location

5 Westowne St
Ste 501
Liberty, MO 64068-3512

Mailing address

5 Westowne St.
Ste 501
Liberty, MO 64068-3512
Phone (816) 781-2110

Other identifiers 1

IdentifierTypeStateIssuer
680014553OtherRAILROAD MEDICARE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Philosophy

Practice roles

OrganizationSpecialtyStatusNew patients
Smock & Associates, Inc. Clinical Past Accepting new patients
Theresa R Hubbard LLC PastSince Oct 12, 2020 Accepting new patients

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1168646400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1325721600000",
    "number": "1063563559",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5 WESTOWNE ST.",
            "address_2": "STE 501",
            "city": "LIBERTY",
            "state": "MO",
            "postal_code": "640683512",
            "telephone_number": "816-781-2110",
            "fax_number": "816-781-2312"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5 WESTOWNE ST",
            "address_2": "STE 501",
            "city": "LIBERTY",
            "state": "MO",
            "postal_code": "640683512",
            "telephone_number": "816-781-2110",
            "fax_number": "816-781-2312"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HARRISON",
        "first_name": "MICHAEL",
        "middle_name": "RICHARD",
        "name_prefix": "Dr.",
        "credential": "PH.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-01-13",
        "last_updated": "2012-01-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "MO",
            "license": "00832",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "680014553",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Liberty, MO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 5, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.