Healthcare Provider Details

I. General information

NPI: 1306587134
Provider Name (Legal Business Name): HARRISON COUNSELING P.L.L.C
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/05/2022
Last Update Date: 04/05/2022
Certification Date: 04/05/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24012 W MAIN ST STE 106
PLAINFIELD IL
60544-2227
US

IV. Provider business mailing address

24012 W MAIN ST STE 106
PLAINFIELD IL
60544-2227
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 TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VII. Legacy identifiers

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

VIII. Authorized Official

Name: KIRIAN HARRISON
Title or Position: OWNER
Credential: LCPC
Phone: 253-249-8931