Provider Demographics
NPI:1124614599
Name:HARRIS, JAMIE RAE (LPC)
Entity type:Individual
Prefix:
First Name:JAMIE
Middle Name:RAE
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 1:908 REBA PL APT 1N
Mailing Address - Street 2:
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60202-2670
Mailing Address - Country:US
Mailing Address - Phone:608-397-2669
Mailing Address - Fax:
Practice Address - Street 1:5537 N CLARK ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60640-1222
Practice Address - Country:US
Practice Address - Phone:773-572-9534
Practice Address - Fax:773-249-1300
Is Sole Proprietor?:No
Enumeration Date:2020-12-18
Last Update Date:2020-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional