Provider Demographics
NPI:1457448276
Name:HIGGINS, HARLAN L (PHD)
Entity Type:Individual
Prefix:DR
First Name:HARLAN
Middle Name:L
Last Name:HIGGINS
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:DR
Other - First Name:HARLAN
Other - Middle Name:L
Other - Last Name:HIGGINS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:16722 TADDINGTON PL
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40245-4291
Mailing Address - Country:US
Mailing Address - Phone:502-445-0470
Mailing Address - Fax:
Practice Address - Street 1:16722 TADDINGTON PL
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40245-4291
Practice Address - Country:US
Practice Address - Phone:502-445-0470
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-05
Last Update Date:2012-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN20040249A103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100131 200AMedicaid
IN274640Medicare ID - Type Unspecified