Provider Demographics
NPI:1699143412
Name:HARVATH, JESSICA L (PHD)
Entity type:Individual
Prefix:DR
First Name:JESSICA
Middle Name:L
Last Name:HARVATH
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:L
Other - Last Name:HARVATH-HILGEMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:50 CRESTWOOD EXECUTIVE CTR STE 308
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63126-1900
Mailing Address - Country:US
Mailing Address - Phone:314-408-7676
Mailing Address - Fax:314-328-5453
Practice Address - Street 1:777 S NEW BALLAS RD STE 129W
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63141-8745
Practice Address - Country:US
Practice Address - Phone:314-408-7676
Practice Address - Fax:314-328-5453
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-10
Last Update Date:2023-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2016035941103T00000X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist