1801873278 NPI number — BETTY L HARPER LCSW

Table of content: BETTY L HARPER LCSW (NPI 1801873278)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1801873278 NPI number — BETTY L HARPER LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HARPER
Provider First Name:
BETTY
Provider Middle Name:
L
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LCSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1801873278
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/04/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 760
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WASHINGTON
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
47501-0760
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
812-254-2760
Provider Business Mailing Address Fax Number:
812-254-8636

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
400 E MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PETERSBURG
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
47567-1245
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
812-354-8785
Provider Business Practice Location Address Fax Number:
812-354-8786
Provider Enumeration Date:
12/28/2005

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: 1041C0700X , with the licence number:  34004154A , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 000000202873 . This is a "ANTHEM BLUE CROSS" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 343422 . This is a "MHN" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".