Provider Demographics
NPI:1699865634
Name:HARMON, CONNIE A
Entity type:Individual
Prefix:MRS
First Name:CONNIE
Middle Name:A
Last Name:HARMON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:CONNIE
Other - Middle Name:L
Other - Last Name:AUSTIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2309 GRANT ST
Mailing Address - Street 2:
Mailing Address - City:BEATRICE
Mailing Address - State:NE
Mailing Address - Zip Code:68310
Mailing Address - Country:US
Mailing Address - Phone:402-228-4455
Mailing Address - Fax:
Practice Address - Street 1:1123 N 9TH ST
Practice Address - Street 2:BLUE VALLEY BEHAVIORAL HEALTH
Practice Address - City:BEATRICE
Practice Address - State:NE
Practice Address - Zip Code:68310-2041
Practice Address - Country:US
Practice Address - Phone:402-228-3386
Practice Address - Fax:402-228-2004
Is Sole Proprietor?:No
Enumeration Date:2006-10-13
Last Update Date:2010-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE156101YM0800X
NE499101YM0800X
NECMSW681041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE47052851509Medicaid
NE47052851581Medicaid
NE47052851505Medicaid
NE47052851515Medicaid
NE47052851500Medicaid
NE47052851506Medicaid
NE47052851508Medicaid
NE47052851513Medicaid
NE47052851514Medicaid
NE47052851507Medicaid
8349OtherMIDLANDS CHOICE
NE47052851501Medicaid
NE47052851517Medicaid
NE57052851504Medicaid
82118OtherBCBS
NE47052851502Medicaid
NE47052851503Medicaid
NE57052851510Medicaid
NE47052851507Medicaid
NE57052851504Medicaid