Provider Demographics
NPI:1003465725
Name:HARMON, ALISA L (MA, ACMHC, NCC)
Entity Type:Individual
Prefix:
First Name:ALISA
Middle Name:L
Last Name:HARMON
Suffix:
Gender:F
Credentials:MA, ACMHC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:735 E THREE FOUNTAINS CIR UNIT 51
Mailing Address - Street 2:
Mailing Address - City:MURRAY
Mailing Address - State:UT
Mailing Address - Zip Code:84107-5249
Mailing Address - Country:US
Mailing Address - Phone:917-748-2011
Mailing Address - Fax:
Practice Address - Street 1:LDS FAMILY SERVICES
Practice Address - Street 2:5698 GLEN EAGLE DRIVE
Practice Address - City:WEST VALLEY CITY
Practice Address - State:UT
Practice Address - Zip Code:84128
Practice Address - Country:US
Practice Address - Phone:801-969-4181
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-05
Last Update Date:2019-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37AC00335600101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health