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NPI Code Detail

MEDICARE: BENJAMIN G. HARRIS, M.A., LCPC, LTD.

MEDICARE: BENJAMIN G. HARRIS, M.A., LCPC, LTD.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YP2500XProfessional Counselor

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1770176794
Entity Type Code : Organization
Provider Name (Legal Business Name) : BENJAMIN G. HARRIS, M.A., LCPC, LTD.
Provider Business Mailing Address
First Line : 1302 PEYTON PL
Second Line :
City : SAINT CHARLES
State : IL
Zip : 60174-5058
Country : US
Telephone Number : 815-761-4257
Fax Number :
Provider Business Practice Location Address
First Line : 3333 WARRENVILLE RD STE 200
Second Line :
City : LISLE
State : IL
Zip : 60532-1999
Country : US
Telephone Number : 630-296-4041
Fax Number :
Authorized Official
Title or Position : PRESIDENT
Name : BENJAMIN G HARRIS
Credential : MA, LCPC
Telephone Number : 815-761-4257
Provider Enumeration Date : 02/20/2021
Last Update Date : 02/20/2021

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