MEDICARE: JAYLA A HARRISON

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106S00000X	Behavior Technician
2	101YM0800X	Mental Health Counselor	180.017988	IL

General Provider Information

NPI Number	:	1619590627
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAYLA A HARRISON

Provider Business Mailing Address
First Line	:	2841 W 99TH PL
Second Line	:
City	:	EVERGREEN PARK
State	:	IL
Zip	:	60805-2656
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2841 W 99TH PL
Second Line	:
City	:	EVERGREEN PARK
State	:	IL
Zip	:	60805-2656
Country	:	US
Telephone Number	:	312-504-1620
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/26/2020
Last Update Date	:	04/16/2026

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Directions to “ JAYLA A HARRISON ” Practice Location

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