Provider Demographics
NPI:1255463477
Name:HARBIN, JERAMIE JUDD (PHD)
Entity type:Individual
Prefix:DR
First Name:JERAMIE
Middle Name:JUDD
Last Name:HARBIN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:325 ADMINISTRATION BUILDING
Mailing Address - Street 2:UNIVERSITY OF ARKANSAS
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72701
Mailing Address - Country:US
Mailing Address - Phone:479-575-5007
Mailing Address - Fax:479-575-7547
Practice Address - Street 1:325 ADMINISTRATION BUILDING
Practice Address - Street 2:UNIVERSITY OF ARKANSAS
Practice Address - City:FAYETTEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72701
Practice Address - Country:US
Practice Address - Phone:479-575-5007
Practice Address - Fax:479-575-7547
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR003P103T00000X, 103TC1900X, 103TH0100X, 103TP2701X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103T00000XBehavioral Health & Social Service ProvidersPsychologist
Not Answered103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
Not Answered103TH0100XBehavioral Health & Social Service ProvidersPsychologistHealth Service
Not Answered103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup Psychotherapy