Provider Demographics
NPI:1104929066
Name:HARLEY, DAVID ARTHUR (PHD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:ARTHUR
Last Name:HARLEY
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 1:1720 WILLOW CREEK DR
Mailing Address - Street 2:
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48917-8848
Mailing Address - Country:US
Mailing Address - Phone:517-321-6858
Mailing Address - Fax:
Practice Address - Street 1:1720 WILLOW CREEK DR
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48917-8848
Practice Address - Country:US
Practice Address - Phone:517-321-6858
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-06
Last Update Date:2014-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301003131103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
0N27250Medicare ID - Type Unspecified