Provider Demographics
NPI:1770176794
Name:BENJAMIN G. HARRIS, M.A., LCPC, LTD.
Entity type:Organization
Organization Name:BENJAMIN G. HARRIS, M.A., LCPC, LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BENJAMIN
Authorized Official - Middle Name:G
Authorized Official - Last Name:HARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LCPC
Authorized Official - Phone:815-761-4257
Mailing Address - Street 1:1302 PEYTON PL
Mailing Address - Street 2:
Mailing Address - City:SAINT CHARLES
Mailing Address - State:IL
Mailing Address - Zip Code:60174-5058
Mailing Address - Country:US
Mailing Address - Phone:815-761-4257
Mailing Address - Fax:
Practice Address - Street 1:3333 WARRENVILLE RD STE 200
Practice Address - Street 2:
Practice Address - City:LISLE
Practice Address - State:IL
Practice Address - Zip Code:60532-1999
Practice Address - Country:US
Practice Address - Phone:630-296-4041
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-20
Last Update Date:2021-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1811122963Medicaid