Provider Demographics
NPI:1336682210
Name:HABEL-SMALL, KARISSA (LPC)
Entity Type:Individual
Prefix:MRS
First Name:KARISSA
Middle Name:
Last Name:HABEL-SMALL
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9611 165TH ST
Mailing Address - Street 2:SUTITE 16
Mailing Address - City:ORLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60467-5654
Mailing Address - Country:US
Mailing Address - Phone:708-949-8688
Mailing Address - Fax:
Practice Address - Street 1:9611 165TH ST
Practice Address - Street 2:SUTITE 16
Practice Address - City:ORLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60467-5654
Practice Address - Country:US
Practice Address - Phone:708-949-8688
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-28
Last Update Date:2016-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178010863101YM0800X, 283Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No283Q00000XHospitalsPsychiatric Hospital