Provider Demographics
NPI:1477535672
Name:HARMON, JANICE SUE (PSYD)
Entity Type:Individual
Prefix:DR
First Name:JANICE
Middle Name:SUE
Last Name:HARMON
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:PO BOX 1117
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:MS
Mailing Address - Zip Code:39130-1117
Mailing Address - Country:US
Mailing Address - Phone:601-941-2236
Mailing Address - Fax:
Practice Address - Street 1:274 PINE TREE LN
Practice Address - Street 2:
Practice Address - City:RIDGELAND
Practice Address - State:MS
Practice Address - Zip Code:39157-8257
Practice Address - Country:US
Practice Address - Phone:601-941-2236
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-15
Last Update Date:2016-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY-06506103TC0700X
MO2001014379103TC0700X, 103TH0100X, 103TR0400X, 103TR0400X, 103TH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TH0100XBehavioral Health & Social Service ProvidersPsychologistHealth Service
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TR0400XBehavioral Health & Social Service ProvidersPsychologistRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1477535672Medicaid
MO1477535672Medicaid
FL54814OtherBCBSF PROVIDER NUMBER
FLE7042Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER
FL3141315OtherAETNA PROVIDER NUMBER