Active NPI
Tilisha Harrison
- Clinical Social Worker
- Round Lake, IL
National Provider Identifier
1386194231
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 149017815
- Practice address
- 31979 N Fish Lake Rd
Round Lake, IL 60073-9517 - Phone
- (847) 546-6450
- NPI assigned
- Oct 4, 2016
- Last updated
- Apr 20, 2017
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 149017815 | IL | Primary |
Addresses
Primary practice location
31979 N Fish Lake Rd
Round Lake, IL 60073-9517
Mailing address
1331 N Harlem Ave
2F
Oak Park, IL 60302-1388
Phone (708) 323-5577
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 149017815 | IL | MD | Clinical Social Worker |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Peace Plus Power | Current | Accepting new patients | |
| TN Harrison Therapeutics | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
- Mental Health Counselor
- Oak Park, IL
- NPI 1609583053
-
- Mental Health Counselor
- Oak Park, IL
- NPI 1982128971
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1475539200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1492646400000",
"number": "1386194231",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1331 N HARLEM AVE",
"address_2": "2F",
"city": "OAK PARK",
"state": "IL",
"postal_code": "603021388",
"telephone_number": "708-323-5577"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "31979 N FISH LAKE RD",
"city": "ROUND LAKE",
"state": "IL",
"postal_code": "600739517",
"telephone_number": "847-546-6450"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HARRISON",
"first_name": "TILISHA",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2016-10-04",
"last_updated": "2017-04-20",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "IL",
"license": "149017815",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Round Lake, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 20, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.