Basic Information
| Provider Information | |||||||||
| NPI: | 1225045172 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HARMS | ||||||||
| FirstName: | BETH | ||||||||
| MiddleName: | ELAINE | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | LISW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 600 4TH ST | ||||||||
| Address2: | SUITE 501 | ||||||||
| City: | SIOUX CITY | ||||||||
| State: | IA | ||||||||
| PostalCode: | 511011750 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7122340220 | ||||||||
| FaxNumber: | 7122340225 | ||||||||
| Practice Location | |||||||||
| Address1: | 600 4TH ST | ||||||||
| Address2: | SUITE 501 | ||||||||
| City: | SIOUX CITY | ||||||||
| State: | IA | ||||||||
| PostalCode: | 511011750 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7122340220 | ||||||||
| FaxNumber: | 7122340225 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/02/2006 | ||||||||
| LastUpdateDate: | 12/21/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X | 01607 | IA | N | Behavioral Health & Social Service Providers | Social Worker | 1041C0700X | 01607 | IA | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
ID Information
| ID | Type | State | Issuer | Description | 01607 | 01 | IA | IA LICENSES | OTHER |