Provider Demographics
NPI:1437283546
Name:GREBASCH, JASON HAROLD (LCPC)
Entity Type:Individual
Prefix:MR
First Name:JASON
Middle Name:HAROLD
Last Name:GREBASCH
Suffix:
Gender:M
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1032 W ALBION AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60626-4612
Mailing Address - Country:US
Mailing Address - Phone:213-327-4295
Mailing Address - Fax:
Practice Address - Street 1:2334 W LAWRENCE AVE
Practice Address - Street 2:204
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60625-1948
Practice Address - Country:US
Practice Address - Phone:773-263-7550
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-14
Last Update Date:2017-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180.009367101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional