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General NPI Number Information
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NPI Number | 1215566781
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Entity Type | Individual
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Provider Name | WILLIE C HARMON SR. LCPC, DOCTORATE
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Gender | Male
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Dates
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Enumeration Date | 04/06/2020
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Last Update Date | 04/06/2020
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Provider Practice Location Address
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Address Line | 1 INGALLS DR
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City | HARVEY
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State | IL
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Zip | 60426-3558
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Country | US
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Telephone | 708-915-5441
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Fax | 708-915-4568
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Provider Business Mailing Address
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Address Line | 315 JACKSON ST
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City | PARK FOREST
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State | IL
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Zip | 60466-1083
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Country | US
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Telephone | 224-532-6108
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 071-006365
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License Number State | IL
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