Individual
JASON RELLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LPC, AMFT
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
178.008877
IL
106H00000X
Marriage & Family Therapist
208.000240
IL
Other
Enumeration date
08/29/2012
Last updated
09/09/2013
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