Provider Demographics
NPI:1730117649
Name:HARMON, GARY (PSYD)
Entity Type:Individual
Prefix:
First Name:GARY
Middle Name:
Last Name:HARMON
Suffix:
Gender:M
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 175
Mailing Address - Street 2:HWY 37 NM10
Mailing Address - City:NOGAL
Mailing Address - State:NM
Mailing Address - Zip Code:88341-0175
Mailing Address - Country:US
Mailing Address - Phone:505-258-4708
Mailing Address - Fax:505-258-3678
Practice Address - Street 1:1096 MECHEM DR
Practice Address - Street 2:SUITE 203
Practice Address - City:RUIDOSO
Practice Address - State:NM
Practice Address - Zip Code:88345-7067
Practice Address - Country:US
Practice Address - Phone:505-258-4708
Practice Address - Fax:505-258-2678
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM479103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMN6029Medicaid