Provider Demographics
NPI:1639410772
Name:DEJAYNES, STEPHEN L (LCPC)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:L
Last Name:DEJAYNES
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 1:414 MACKENIE PLACE
Mailing Address - Street 2:
Mailing Address - City:GERMANTOWN HILLS
Mailing Address - State:IL
Mailing Address - Zip Code:61548
Mailing Address - Country:US
Mailing Address - Phone:309-256-1654
Mailing Address - Fax:
Practice Address - Street 1:100 HILLCREST DRIVE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:IL
Practice Address - Zip Code:61571
Practice Address - Country:US
Practice Address - Phone:309-444-2800
Practice Address - Fax:309-444-2866
Is Sole Proprietor?:No
Enumeration Date:2013-03-14
Last Update Date:2013-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1041C700X101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health