Provider Demographics
NPI:1982128971
Name:TN HARRISON THERAPEUTICS
Entity Type:Organization
Organization Name:TN HARRISON THERAPEUTICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST
Authorized Official - Prefix:MS
Authorized Official - First Name:TILISHA
Authorized Official - Middle Name:
Authorized Official - Last Name:HARRISON
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:708-323-5577
Mailing Address - Street 1:1331 N HARLEM AVE
Mailing Address - Street 2:
Mailing Address - City:OAK PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60302-1388
Mailing Address - Country:US
Mailing Address - Phone:708-323-5577
Mailing Address - Fax:
Practice Address - Street 1:1331 NORTH HARLEM AVE
Practice Address - Street 2:2F
Practice Address - City:OAK PARK
Practice Address - State:IL
Practice Address - Zip Code:60302-6030
Practice Address - Country:US
Practice Address - Phone:708-323-5577
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-01
Last Update Date:2017-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.017815101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty