Provider Demographics
NPI:1629411244
Name:HARRIS, FARAH (MA, LCPC)
Entity Type:Individual
Prefix:MRS
First Name:FARAH
Middle Name:
Last Name:HARRIS
Suffix:
Gender:F
Credentials:MA, LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 816
Mailing Address - Street 2:
Mailing Address - City:FLOSSMOOR
Mailing Address - State:IL
Mailing Address - Zip Code:60422-0816
Mailing Address - Country:US
Mailing Address - Phone:708-866-0208
Mailing Address - Fax:
Practice Address - Street 1:19624 GOVERNORS HWY STE 4
Practice Address - Street 2:
Practice Address - City:FLOSSMOOR
Practice Address - State:IL
Practice Address - Zip Code:60422-2086
Practice Address - Country:US
Practice Address - Phone:708-866-0208
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-04-12
Last Update Date:2017-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180010817101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health