1245376912 NPI number — MR. DAVE EDWARD HARMON

Table of content: MR. DAVE EDWARD HARMON (NPI 1245376912)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1245376912 NPI number — MR. DAVE EDWARD HARMON

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HARMON
Provider First Name:
DAVE
Provider Middle Name:
EDWARD
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
HARMON
Provider Other First Name:
DAVE
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
LCSW, CADC, ICADC
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1245376912
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4010 DUPONT CIR
Provider Second Line Business Mailing Address:
SUITE 226
Provider Business Mailing Address City Name:
LOUISVILLE
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
40207-4812
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
502-896-8006
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4010 DUPONT CIR
Provider Second Line Business Practice Location Address:
SUITE 226
Provider Business Practice Location Address City Name:
LOUISVILLE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40207-4812
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-896-8006
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/30/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101Y00000X , with the licence number:  74 DOM VIOLENCE , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 101Y00000X , with the licence number: 32 SEX OFFENDER COUN , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 101Y00000X , with the licence number: 418 PRO GAMBL, ACGCC , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 101YA0400X , with the licence number: 0037 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 101YA0400X , with the licence number: 8027 NADAC , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 1041C0700X , with the licence number: 290 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 418 . This is a "NATIONAL, COMP GAMBLING" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 290 . This is a "LCSW" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 74 . This is a "DOMESTIC VIOLENCE COUNSEL" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 32 . This is a "SEX OFFENDER COUNSELOR" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: OO37 . This is a "CADC, CHEMICAL DEP" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 8207 . This is a "NADAC CHEM DEP, NATION" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 90208 . This is a "NATIONAL- NADAC" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".




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