Provider Demographics
NPI:1881744340
Name:HARVEY, THEODORE LEWIS (LCPC)
Entity type:Individual
Prefix:MR
First Name:THEODORE
Middle Name:LEWIS
Last Name:HARVEY
Suffix:
Gender:M
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:218 MAIN STREET
Mailing Address - Street 2:P.O.BOX 68
Mailing Address - City:FRANKLIN
Mailing Address - State:IL
Mailing Address - Zip Code:62638
Mailing Address - Country:US
Mailing Address - Phone:217-675-2042
Mailing Address - Fax:
Practice Address - Street 1:1700 S SPRING ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:IL
Practice Address - Zip Code:62704-3961
Practice Address - Country:US
Practice Address - Phone:217-473-8117
Practice Address - Fax:217-243-8050
Is Sole Proprietor?:No
Enumeration Date:2007-01-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional