Healthcare Provider Details

I. General information

NPI: 1982128971
Provider Name (Legal Business Name): TN HARRISON THERAPEUTICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/01/2017
Last Update Date: 08/01/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1331 NORTH HARLEM AVE 2F
OAK PARK IL
60302-6030
US

IV. Provider business mailing address

1331 N HARLEM AVE
OAK PARK IL
60302-1388
US

V. Phone/Fax

Practice location:
  • Phone: 708-323-5577
  • Fax:
Mailing address:
  • Phone: 708-323-5577
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number149.017815
License Number StateIL

VIII. Authorized Official

Name: MS. TILISHA HARRISON
Title or Position: THERAPIST
Credential: LCSW
Phone: 708-323-5577