Individual
DEREK BASTIAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MA
Contact information
Practice address
88 S MAIN ST, GLEN CARBON, IL 62034-1415
(618) 288-8085
Mailing address
88 S MAIN ST, GLEN CARBON, IL 62034-1415
(618) 288-8085
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
Other
Enumeration date
01/28/2026
Last updated
01/28/2026
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