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General NPI Number Information
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NPI Number | 1578847042
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Entity Type | Organization
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Legal Business Name | HARMONY CENTER FOR HOLISTIC PSYCHOTHERAPY
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Dates
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Enumeration Date | 10/03/2011
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Last Update Date | 10/03/2011
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Provider Practice Location Address
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Address Line | 6625 N 2ND ST
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City | LOVES PARK
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State | IL
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Zip | 61111-3744
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Country | US
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Telephone | 815-639-0300
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Fax | 815-639-0303
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Provider Business Mailing Address
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Address Line | 6625 N 2ND ST
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City | LOVES PARK
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State | IL
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Zip | 61111-3744
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Country | US
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Telephone | 815-639-0300
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Fax | 815-639-0303
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Authorized Official
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Title or Position | PSYCHOLOGIST
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Name | DR. LISA A. BREISCH
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Credential | PSY.D.
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Telephone | 815-639-0300
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 180003465
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License Number State | IL
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