Mikkal Harris, LCPC

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

180007145 Issued in IL

Practice address

4749 Lincoln Mall Dr
#202
Matteson, IL 60443-2348

Phone

(708) 833-8887

Fax

(708) 827-0555

NPI assigned

Nov 4, 2009

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1257292800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1257292800000",
    "number": "1942537477",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8660 S 86TH AVE",
            "address_2": "#310",
            "city": "JUSTICE",
            "state": "IL",
            "postal_code": "604582127",
            "telephone_number": "773-733-1773",
            "fax_number": "708-458-7930"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4749 LINCOLN MALL DR",
            "address_2": "#202",
            "city": "MATTESON",
            "state": "IL",
            "postal_code": "604432348",
            "telephone_number": "708-833-8887",
            "fax_number": "708-827-0555"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HARRIS",
        "first_name": "MIKKAL",
        "name_prefix": "Mr.",
        "credential": "LCPC",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2009-11-04",
        "last_updated": "2009-11-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "IL",
            "license": "180007145",
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "IL",
            "license": "180007145",
            "primary": true
        },
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "IL",
            "license": "180007145",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Demetria Guider
• Sharon Gunn, P.T.
• Anjum Hameeduddin, M.D.
• Alyssa Hamilton
• Mark Harris, LCSW
• Derrick Lawrence Hassert, PH.D.
• Tinica Hautman
• Claressa Hawkins, FNP-BC
• Ladell Hawkins
• Hawthorne Developmental Agency

• Professional Counselor in Matteson, IL
• Providers in Matteson, IL by specialty
• Professional Counselor in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 4, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.