Provider Demographics
NPI:1245407170
Name:HARPOOL, RITA (PSYD)
Entity Type:Individual
Prefix:DR
First Name:RITA
Middle Name:
Last Name:HARPOOL
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:429 N FRANKLIN ST
Mailing Address - Street 2:
Mailing Address - City:MADISONVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42431-1730
Mailing Address - Country:US
Mailing Address - Phone:270-836-1179
Mailing Address - Fax:
Practice Address - Street 1:429 N FRANKLIN ST
Practice Address - Street 2:
Practice Address - City:MADISONVILLE
Practice Address - State:KY
Practice Address - Zip Code:42431-1730
Practice Address - Country:US
Practice Address - Phone:270-836-1179
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-09
Last Update Date:2020-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY130703103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100240540Medicaid
K066761Medicare PIN
KYQ09558Medicare UPIN