Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 102L00000X | Psychologist | 003P | AR |
N | 103T00000X | Psychologist | 003P | AR |
N | 103TC1900X | Counseling Psychologist | 003P | AR |
N | 103TH0100X | Health Service | 003P | AR |
N | 103TP2701X | Group Psychotherapist | 003P | AR |
NPI | 1255463477 |
---|---|
Provider Name | Dr. Jeramie Judd Harbin |
First Address | Fayetteville, AR 72701 |
Second Address | Fayetteville, AR 72701 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/03/2007 |
Last Update Date | 08/07/2007 |