Provider Demographics
NPI:1932471919
Name:HARPER, JODY ANN (MA PPC)
Entity Type:Individual
Prefix:MRS
First Name:JODY
Middle Name:ANN
Last Name:HARPER
Suffix:
Gender:F
Credentials:MA PPC
Other - Prefix:
Other - First Name:JODY
Other - Middle Name:ANN
Other - Last Name:KIMBREL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:136 WEST 21ST AVE.
Mailing Address - Street 2:
Mailing Address - City:TORRINGTON
Mailing Address - State:WY
Mailing Address - Zip Code:82240
Mailing Address - Country:US
Mailing Address - Phone:307-532-2119
Mailing Address - Fax:307-532-3117
Practice Address - Street 1:136 WEST 21ST AVE.
Practice Address - Street 2:
Practice Address - City:TORRINGTON
Practice Address - State:WY
Practice Address - Zip Code:82240
Practice Address - Country:US
Practice Address - Phone:307-532-2119
Practice Address - Fax:307-532-3117
Is Sole Proprietor?:No
Enumeration Date:2012-02-06
Last Update Date:2012-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYPPC-630101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional