Provider Demographics
NPI:1578847042
Name:HARMONY CENTER FOR HOLISTIC PSYCHOTHERAPY
Entity Type:Organization
Organization Name:HARMONY CENTER FOR HOLISTIC PSYCHOTHERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:LISA
Authorized Official - Middle Name:A
Authorized Official - Last Name:BREISCH
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:815-639-0300
Mailing Address - Street 1:6625 N 2ND ST
Mailing Address - Street 2:
Mailing Address - City:LOVES PARK
Mailing Address - State:IL
Mailing Address - Zip Code:61111-3744
Mailing Address - Country:US
Mailing Address - Phone:815-639-0300
Mailing Address - Fax:815-639-0303
Practice Address - Street 1:6625 N 2ND ST
Practice Address - Street 2:
Practice Address - City:LOVES PARK
Practice Address - State:IL
Practice Address - Zip Code:61111-3744
Practice Address - Country:US
Practice Address - Phone:815-639-0300
Practice Address - Fax:815-639-0303
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LISA A. BREISCH, PSY.D.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-10-03
Last Update Date:2011-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180003465103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty