Healthcare Provider Details

I. General information

NPI: 1699865634
Provider Name (Legal Business Name): MRS. CONNIE A HARMON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CONNIE L AUSTIN

II. Dates (important events)

Enumeration Date: 10/13/2006
Last Update Date: 07/20/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1123 N 9TH ST BLUE VALLEY BEHAVIORAL HEALTH
BEATRICE NE
68310-2041
US

IV. Provider business mailing address

2309 GRANT ST
BEATRICE NE
68310
US

V. Phone/Fax

Practice location:
  • Phone: 402-228-3386
  • Fax: 402-228-2004
Mailing address:
  • Phone: 402-228-4455
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number156
License Number StateNE
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number499
License Number StateNE
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCMSW68
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: