Provider Demographics
NPI:1518383181
Name:HARMON, CHAD ALVIN (LAC)
Entity Type:Individual
Prefix:MR
First Name:CHAD
Middle Name:ALVIN
Last Name:HARMON
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:731 N WATER ST STE 2
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67203-3855
Mailing Address - Country:US
Mailing Address - Phone:316-267-3825
Mailing Address - Fax:316-267-3843
Practice Address - Street 1:731 N WATER ST STE 2
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67203-3855
Practice Address - Country:US
Practice Address - Phone:316-267-3825
Practice Address - Fax:316-267-3843
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-06
Last Update Date:2014-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS499101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)