Active NPI
Jason Relle, LPC, AMFT
- Professional Counselor
- Rockford, IL
National Provider Identifier
1306194923
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- 178.008877
- Practice address
- 8616 Northern Ave
Rockford, IL 61107-5309 - Phone
- (815) 338-8003
- Fax
- (815) 332-6090
- NPI assigned
- Aug 29, 2012
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | 178.008877 | IL | Primary |
| Marriage & Family Therapist | 106H00000X | 208.000240 | IL |
Addresses
Primary practice location
8616 Northern Ave
Rockford, IL 61107-5309
Mailing address
1021 N Mulford Rd
Rockford, IL 61107-3877
Phone (815) 387-5600
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 178.008877 | IL | MD | Professional Counselor |
| 208.000240 | IL | MD | Marriage & Family Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1346198400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1378684800000",
"number": "1306194923",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1021 N MULFORD RD",
"city": "ROCKFORD",
"state": "IL",
"postal_code": "611073877",
"telephone_number": "815-387-5600",
"fax_number": "815-391-5041"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "8616 NORTHERN AVE",
"city": "ROCKFORD",
"state": "IL",
"postal_code": "611075309",
"telephone_number": "815-338-8003",
"fax_number": "815-332-6090"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RELLE",
"first_name": "JASON",
"credential": "LPC, AMFT",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2012-08-29",
"last_updated": "2013-09-09",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "IL",
"license": "178.008877",
"primary": true
},
{
"code": "106H00000X",
"taxonomy_group": "",
"desc": "Marriage & Family Therapist",
"state": "IL",
"license": "208.000240",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Rockford, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 9, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.