Provider Demographics
NPI:1376628719
Name:HARMS, JENNIFER RANAE
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:RANAE
Last Name:HARMS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:433 S GLENDALE ST
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67218-1536
Mailing Address - Country:US
Mailing Address - Phone:316-371-6914
Mailing Address - Fax:
Practice Address - Street 1:5745 E CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67208-4202
Practice Address - Country:US
Practice Address - Phone:316-315-2121
Practice Address - Fax:316-315-2122
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-26
Last Update Date:2024-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS341106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist