Provider Demographics
NPI:1700093861
Name:SMITH-HARRIS, AMY KATHERINE (LCPC, ATR)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:KATHERINE
Last Name:SMITH-HARRIS
Suffix:
Gender:F
Credentials:LCPC, ATR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1111 KRELL DR
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62711-7371
Mailing Address - Country:US
Mailing Address - Phone:217-721-5780
Mailing Address - Fax:
Practice Address - Street 1:7000 PIPER GLEN DR
Practice Address - Street 2:SUITE E
Practice Address - City:SPRINGFIELD
Practice Address - State:IL
Practice Address - Zip Code:62711-6756
Practice Address - Country:US
Practice Address - Phone:217-721-5780
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-17
Last Update Date:2015-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180003608101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional