Healthcare Provider Details

I. General information

NPI: 1912423823
Provider Name (Legal Business Name): JENNI HARSHBARGER, PHD, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/22/2017
Last Update Date: 12/10/2024
Certification Date: 12/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 E. DOUGLAS REGUS SUITES, 2ND FLOOR
WICHITA KS
67202
US

IV. Provider business mailing address

100 S MAIN ST STE 505
WICHITA KS
67202-3738
US

V. Phone/Fax

Practice location:
  • Phone: 316-688-8390
  • Fax: 316-688-8390
Mailing address:
  • Phone: 316-688-8390
  • Fax: 316-867-1718

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number1646
License Number StateKS
# 2
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number1646
License Number StateKS

VIII. Authorized Official

Name: DR. JENNI LEE HARSHBARGER
Title or Position: CLINICAL PSYCHOLOGIST
Credential: PHD
Phone: 316-688-8390