Provider Demographics
NPI:1629350996
Name:HARMON, KAYVRYELLE LATEASE (BA, AA)
Entity Type:Individual
Prefix:MISS
First Name:KAYVRYELLE
Middle Name:LATEASE
Last Name:HARMON
Suffix:
Gender:F
Credentials:BA, AA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:214 SW 30TH ST
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73109-6506
Mailing Address - Country:US
Mailing Address - Phone:405-272-1610
Mailing Address - Fax:
Practice Address - Street 1:214 SW 30TH
Practice Address - Street 2:
Practice Address - City:OKLAHOMA
Practice Address - State:OK
Practice Address - Zip Code:73109
Practice Address - Country:US
Practice Address - Phone:405-272-1610
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-13
Last Update Date:2011-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKG082059945101YS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool