Provider Demographics
NPI:1770970964
Name:HARSY, ANGELA RAE (MS BCBA)
Entity type:Individual
Prefix:MRS
First Name:ANGELA
Middle Name:RAE
Last Name:HARSY
Suffix:
Gender:F
Credentials:MS BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:847 WELLS STREET RD
Mailing Address - Street 2:
Mailing Address - City:DU QUOIN
Mailing Address - State:IL
Mailing Address - Zip Code:62832-4161
Mailing Address - Country:US
Mailing Address - Phone:618-559-2169
Mailing Address - Fax:
Practice Address - Street 1:847 WELLS STREET RD
Practice Address - Street 2:
Practice Address - City:DU QUOIN
Practice Address - State:IL
Practice Address - Zip Code:62832-4161
Practice Address - Country:US
Practice Address - Phone:618-559-2169
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-25
Last Update Date:2015-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1-14-16352103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst