Provider Demographics
NPI:1093359259
Name:HARSHBERGER, JASON C (BS)
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:C
Last Name:HARSHBERGER
Suffix:
Gender:M
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1056
Mailing Address - Street 2:
Mailing Address - City:RAWLINS
Mailing Address - State:WY
Mailing Address - Zip Code:82301-1056
Mailing Address - Country:US
Mailing Address - Phone:307-324-7156
Mailing Address - Fax:307-328-1651
Practice Address - Street 1:721 W MAPLE ST
Practice Address - Street 2:
Practice Address - City:RAWLINS
Practice Address - State:WY
Practice Address - Zip Code:82301-5447
Practice Address - Country:US
Practice Address - Phone:307-324-7156
Practice Address - Fax:307-328-1651
Is Sole Proprietor?:No
Enumeration Date:2019-10-31
Last Update Date:2022-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X
WYLPC-2089101YP2500X
WYPPC-1231101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
No101Y00000XBehavioral Health & Social Service ProvidersCounselor