Provider Demographics
NPI:1821008335
Name:HARMON, LENA A (LPP)
Entity Type:Individual
Prefix:
First Name:LENA
Middle Name:A
Last Name:HARMON
Suffix:
Gender:F
Credentials:LPP
Other - Prefix:
Other - First Name:LENA
Other - Middle Name:A
Other - Last Name:BROWN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPP
Mailing Address - Street 1:1448 DIEDERICH BLVD
Mailing Address - Street 2:
Mailing Address - City:RUSSELL
Mailing Address - State:KY
Mailing Address - Zip Code:41169-1719
Mailing Address - Country:US
Mailing Address - Phone:606-834-0020
Mailing Address - Fax:606-834-0049
Practice Address - Street 1:1448 DIEDERICH BLVD
Practice Address - Street 2:
Practice Address - City:RUSSELL
Practice Address - State:KY
Practice Address - Zip Code:41169
Practice Address - Country:US
Practice Address - Phone:606-834-0020
Practice Address - Fax:606-834-0049
Is Sole Proprietor?:No
Enumeration Date:2006-08-08
Last Update Date:2020-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY0114103TB0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
Provider Identifiers
StateIdentifier IDID TypeIssuer
11751686OtherCAQH
KY7100281080Medicaid
000000239397OtherANTHEM BCBS
100010OtherCHA
000000239397OtherANTHEM BCBS