Healthcare Provider Details

I. General information

NPI: 1588143499
Provider Name (Legal Business Name): HILARY R HARRIS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/10/2018
Last Update Date: 02/23/2026
Certification Date: 02/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

668 WATERFORD DR
GRAYSLAKE IL
60030-3824
US

IV. Provider business mailing address

310 S GREENLEAF ST STE 207
GURNEE IL
60031-5708
US

V. Phone/Fax

Practice location:
  • Phone: 708-692-3194
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL
# 3
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number178.010021
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: