Provider Demographics
NPI:1881881019
Name:HARMON, JESSICA (LCMFT, LCAC)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:HARMON
Suffix:
Gender:F
Credentials:LCMFT, LCAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7117 W HARRY ST UNIT 12331
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67277-7650
Mailing Address - Country:US
Mailing Address - Phone:316-390-4575
Mailing Address - Fax:
Practice Address - Street 1:501 S TURQUOISE ST
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67209
Practice Address - Country:US
Practice Address - Phone:316-390-4575
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-02
Last Update Date:2019-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS75101YA0400X
KS2836106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS546720Medicaid