Provider Demographics
NPI:1447425863
Name:TASSON, FABIAN (LCPC)
Entity Type:Individual
Prefix:
First Name:FABIAN
Middle Name:
Last Name:TASSON
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 1:3000 PROFESSIONAL DR STE A
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62703-5943
Mailing Address - Country:US
Mailing Address - Phone:217-793-9593
Mailing Address - Fax:217-793-6949
Practice Address - Street 1:3000 PROFESSIONAL DR STE A
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:IL
Practice Address - Zip Code:62703-5943
Practice Address - Country:US
Practice Address - Phone:217-793-9593
Practice Address - Fax:217-793-6949
Is Sole Proprietor?:No
Enumeration Date:2008-04-27
Last Update Date:2008-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180002118101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health