Healthcare Provider Details

I. General information

NPI: 1972260081
Provider Name (Legal Business Name): KIRIAN JANE HARRISON LCPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/23/2021
Last Update Date: 11/23/2021
Certification Date: 11/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16222 BURGUNDY DR
PLAINFIELD IL
60586-8284
US

IV. Provider business mailing address

16222 BURGUNDY DR
PLAINFIELD IL
60586-8284
US

V. Phone/Fax

Practice location:
  • Phone: 253-249-8931
  • Fax:
Mailing address:
  • Phone: 253-249-8931
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number39003291A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number180.014007
License Number StateIL

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: