Healthcare Provider Details

I. General information

NPI: 1578714341
Provider Name (Legal Business Name): JEAN MARIE HARMON M. ED., LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/09/2008
Last Update Date: 08/25/2023
Certification Date: 08/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 S WOODLAWN AVE STE 15
O FALLON MO
63366-7647
US

IV. Provider business mailing address

801 S WOODLAWN AVE STE 15
O FALLON MO
63366-7647
US

V. Phone/Fax

Practice location:
  • Phone: 636-379-1779
  • Fax: 636-634-3496
Mailing address:
  • Phone: 636-379-1779
  • Fax: 636-634-3496

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number000214
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: