| Theodore Harris, Lcsw, Llc | |
|
53 W Jackson Blvd Suite 404 Chicago IL 60604-3606 | |
| (312) 576-5760 | |
| Not Available |
| Full Name | Theodore Harris, Lcsw, Llc |
|---|---|
| Speciality | Social Worker - Clinical |
| Location | 53 W Jackson Blvd, Chicago, Illinois |
| Authorized Official Name and Position | Theodore R Harris (OWNER) |
| Authorized Official Contact | 3125765760 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Theodore Harris, Lcsw, Llc 927 Asbury Ave Evanston IL 60202-1637 Ph: (773) 680-1534 | Theodore Harris, Lcsw, Llc 53 W Jackson Blvd Suite 404 Chicago IL 60604-3606 Ph: (312) 576-5760 |
| NPI Number | 1144644261 |
|---|---|
| Provider Enumeration Date | 02/10/2014 |
| Last Update Date | 10/13/2016 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1144644261 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | 149016113 (Illinois) | Primary |
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