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Individual

JASON RELLE

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
LPC, AMFT

Contact information

Practice address
8616 NORTHERN AVE, ROCKFORD, IL 61107-5309
(815) 338-8003
(815) 332-6090
Mailing address
1021 N MULFORD RD, ROCKFORD, IL 61107-3877
(815) 387-5600
(815) 391-5041

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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