Provider Demographics
NPI:1821108952
Name:HARVILLE, JUDY M (LCSW)
Entity Type:Individual
Prefix:
First Name:JUDY
Middle Name:M
Last Name:HARVILLE
Suffix:
Gender:F
Credentials:LCSW
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 1160
Mailing Address - Street 2:
Mailing Address - City:MAGEE
Mailing Address - State:MS
Mailing Address - Zip Code:39111-1160
Mailing Address - Country:US
Mailing Address - Phone:601-849-4221
Mailing Address - Fax:601-849-7188
Practice Address - Street 1:900 1ST AVE NE
Practice Address - Street 2:
Practice Address - City:MAGEE
Practice Address - State:MS
Practice Address - Zip Code:39111-3255
Practice Address - Country:US
Practice Address - Phone:601-849-4221
Practice Address - Fax:601-849-7188
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2008-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSC48612084P0804X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00126306Medicaid