Provider Demographics
NPI:1407321458
Name:PERRY, JASA (LCPC)
Entity type:Individual
Prefix:
First Name:JASA
Middle Name:
Last Name:PERRY
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16000 VAN DRUNEN RD
Mailing Address - Street 2:
Mailing Address - City:SOUTH HOLLAND
Mailing Address - State:IL
Mailing Address - Zip Code:60473-1242
Mailing Address - Country:US
Mailing Address - Phone:312-650-9413
Mailing Address - Fax:312-270-0459
Practice Address - Street 1:16000 VAN DRUNEN RD
Practice Address - Street 2:
Practice Address - City:SOUTH HOLLAND
Practice Address - State:IL
Practice Address - Zip Code:60473-1242
Practice Address - Country:US
Practice Address - Phone:312-650-9413
Practice Address - Fax:312-270-0459
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-05
Last Update Date:2024-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180015424101Y00000X, 101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health