Provider Demographics
NPI:1477606473
Name:JAN S HARMON PSYD PA
Entity Type:Organization
Organization Name:JAN S HARMON PSYD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CORPORATE PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JANICE
Authorized Official - Middle Name:SUE
Authorized Official - Last Name:HARMON
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:941-404-9523
Mailing Address - Street 1:PO BOX 806
Mailing Address - Street 2:
Mailing Address - City:RICHLAND
Mailing Address - State:MO
Mailing Address - Zip Code:65556-0806
Mailing Address - Country:US
Mailing Address - Phone:941-404-9523
Mailing Address - Fax:
Practice Address - Street 1:209 DUBLIN LANE
Practice Address - Street 2:
Practice Address - City:RICHLAND
Practice Address - State:MO
Practice Address - Zip Code:65556
Practice Address - Country:US
Practice Address - Phone:941-404-9523
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-21
Last Update Date:2012-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY6506103G00000X, 103TC0700X
MO2001014379103G00000X, 103TC0700X, 103TH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Multi-Specialty
No103TH0100XBehavioral Health & Social Service ProvidersPsychologistHealth ServiceGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL3141315OtherAETNA-PRESIDENT'S ID
FL54814OtherBCBSF PRESIDENT'S ID
FLE7042Medicare ID - Type UnspecifiedPRESIDENT'S ID