Provider Demographics
NPI:1326409376
Name:HARMON, JACLYN JANICE (LPC)
Entity type:Individual
Prefix:
First Name:JACLYN
Middle Name:JANICE
Last Name:HARMON
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7712 LAKEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:FAIRVIEW
Mailing Address - State:PA
Mailing Address - Zip Code:16415-1207
Mailing Address - Country:US
Mailing Address - Phone:814-602-7552
Mailing Address - Fax:
Practice Address - Street 1:7712 LAKEWOOD DR
Practice Address - Street 2:
Practice Address - City:FAIRVIEW
Practice Address - State:PA
Practice Address - Zip Code:16415-1207
Practice Address - Country:US
Practice Address - Phone:814-602-7552
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-17
Last Update Date:2024-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC008795101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1034203150002Medicaid