Provider Demographics
NPI:1700498912
Name:HARRIS, AIMEE (LPC)
Entity Type:Individual
Prefix:
First Name:AIMEE
Middle Name:
Last Name:HARRIS
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1716 FORDEM AVE
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53704-4604
Mailing Address - Country:US
Mailing Address - Phone:608-221-3511
Mailing Address - Fax:608-807-5675
Practice Address - Street 1:1716 FORDEM AVE
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53704-4604
Practice Address - Country:US
Practice Address - Phone:608-221-3511
Practice Address - Fax:608-807-5675
Is Sole Proprietor?:No
Enumeration Date:2020-08-19
Last Update Date:2022-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2429101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI2429OtherWISCONSIN DEPARTMENT OF SAFETY AND PROFESSIONAL SERVICES