Provider Demographics
NPI:1710360458
Name:PATRICIA HARTHUN LCPC LTD
Entity Type:Organization
Organization Name:PATRICIA HARTHUN LCPC LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:HARTHUN
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC
Authorized Official - Phone:312-835-7976
Mailing Address - Street 1:10725 S WESTERN AVE
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60643-3135
Mailing Address - Country:US
Mailing Address - Phone:312-835-7976
Mailing Address - Fax:773-239-9857
Practice Address - Street 1:10725 S WESTERN AVE
Practice Address - Street 2:2ND FLOOR
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60643-3135
Practice Address - Country:US
Practice Address - Phone:312-835-7976
Practice Address - Fax:773-239-9857
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-30
Last Update Date:2015-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180005415101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1306866132OtherSOLE PRACTIONER NPI