Individual
JASON DEFORD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LCPC
Contact information
Practice address
3020 W WILLOW KNOLLS DR, PEORIA, IL 61614-8127
(309) 681-5652
Mailing address
3020 W WILLOW KNOLLS DR, PEORIA, IL 61614-8127
(309) 681-5652
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
180010119
IL
Other
Enumeration date
08/19/2016
Last updated
08/19/2016
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