Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YS0200X | School Counselor | IL |
NPI | 1063071843 |
---|---|
Provider Name | Dr. Henry Lee Harden |
First Address | Chicago, IL 60620-4747 |
Second Address | Chicago, IL 60620-4747 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/06/2019 |
Last Update Date | 06/06/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
PPO17824 | BCBS (01) | IL |