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General NPI Number Information
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NPI Number | 1366940868
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Entity Type | Organization
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Legal Business Name | JEANNINE HARRIS COUNSELING SERVICES, LLC
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Dates
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Enumeration Date | 01/30/2018
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Last Update Date | 11/02/2018
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Provider Practice Location Address
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Address Line | 10540 S WESTERN AVE
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City | CHICAGO
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State | IL
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Zip | 60643-2536
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Country | US
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Telephone | 708-940-2847
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 439465
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City | CHICAGO
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State | IL
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Zip | 60643-9465
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Country | US
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Telephone | 708-774-1929
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | JEANNINE HARRIS
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Credential | LCSW
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Telephone | 708-774-1929
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 149.017907
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License Number State | IL
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