Provider Demographics
NPI:1316976830
Name:HARNISHFEGER, BRADY RICHARD (PHD)
Entity type:Individual
Prefix:MR
First Name:BRADY
Middle Name:RICHARD
Last Name:HARNISHFEGER
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:8228 HERITAGE DR
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49009-9613
Mailing Address - Country:US
Mailing Address - Phone:269-544-0286
Mailing Address - Fax:269-341-9735
Practice Address - Street 1:1011 W MAPLE ST
Practice Address - Street 2:STE 200
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49008-5800
Practice Address - Country:US
Practice Address - Phone:269-341-9745
Practice Address - Fax:269-341-9735
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2016-12-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI6301008153103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical