Healthcare Provider Details

I. General information

NPI: 1477606473
Provider Name (Legal Business Name): JAN S HARMON PSYD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/21/2007
Last Update Date: 04/19/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

209 DUBLIN LANE
RICHLAND MO
65556
US

IV. Provider business mailing address

PO BOX 806
RICHLAND MO
65556-0806
US

V. Phone/Fax

Practice location:
  • Phone: 941-404-9523
  • Fax:
Mailing address:
  • Phone: 941-404-9523
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License NumberPY6506
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number2001014379
License Number StateMO
# 3
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number2001014379
License Number StateMO
# 4
Primary TaxonomyN
Taxonomy Code103TH0100X
TaxonomyHealth Service Psychologist
License Number2001014379
License Number StateMO
# 5
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPY6506
License Number StateFL

VIII. Authorized Official

Name: DR. JANICE SUE HARMON
Title or Position: CORPORATE PRESIDENT
Credential: PSYD
Phone: 941-404-9523