Healthcare Provider Details

I. General information

NPI: 1295977452
Provider Name (Legal Business Name): DEBRA JO HARLAN MSW, LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/01/2009
Last Update Date: 11/10/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

777 E BATTLEFIELD ST SUITE 102, B
SPRINGFIELD MO
65807-4807
US

IV. Provider business mailing address

201 E HARDY ST
REPUBLIC MO
65738-2249
US

V. Phone/Fax

Practice location:
  • Phone: 417-597-4572
  • Fax:
Mailing address:
  • Phone: 417-207-6908
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number2009006125
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: