Provider Demographics
NPI:1306491295
Name:HAROLD, JESSE (LPC)
Entity type:Individual
Prefix:
First Name:JESSE
Middle Name:
Last Name:HAROLD
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6331 N LAKEWOOD AVE FL 2
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60660-1570
Mailing Address - Country:US
Mailing Address - Phone:773-706-1009
Mailing Address - Fax:
Practice Address - Street 1:935 W CHESTNUT ST STE 204
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60642-5445
Practice Address - Country:US
Practice Address - Phone:888-726-7170
Practice Address - Fax:312-226-9082
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-07
Last Update Date:2019-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178005288101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional