Provider Demographics
NPI:1194810085
Name:HARNESS, KIM MARIE
Entity type:Individual
Prefix:MS
First Name:KIM
Middle Name:MARIE
Last Name:HARNESS
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:KIM
Other - Middle Name:HARNESS
Other - Last Name:MAJORS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, LPC
Mailing Address - Street 1:4680 ALLEMANIA STREET
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63116-1002
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:11116 S TOWNE SQ
Practice Address - Street 2:SUITE 204
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63123-7809
Practice Address - Country:US
Practice Address - Phone:314-650-1063
Practice Address - Fax:314-892-3555
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2010-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO002557101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health