Provider Demographics
NPI:1265283402
Name:HARRIS, ANN GENETTI (LPC)
Entity type:Individual
Prefix:
First Name:ANN
Middle Name:GENETTI
Last Name:HARRIS
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:ANN
Other - Middle Name:ELIZABETH
Other - Last Name:GENETTI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1011 LAKE ST STE 307
Mailing Address - Street 2:
Mailing Address - City:OAK PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60301-1138
Mailing Address - Country:US
Mailing Address - Phone:872-395-8091
Mailing Address - Fax:
Practice Address - Street 1:1011 LAKE ST STE 307
Practice Address - Street 2:
Practice Address - City:OAK PARK
Practice Address - State:IL
Practice Address - Zip Code:60301-1138
Practice Address - Country:US
Practice Address - Phone:872-395-8091
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-27
Last Update Date:2024-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178.019752101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional