Provider Demographics
NPI:1740770742
Name:REEL-HAAS, JASON DANIEL (LCPC)
Entity Type:Individual
Prefix:MR
First Name:JASON
Middle Name:DANIEL
Last Name:REEL-HAAS
Suffix:
Gender:M
Credentials:LCPC
Other - Prefix:MR
Other - First Name:JASON
Other - Middle Name:DANIEL
Other - Last Name:HAAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCPC
Mailing Address - Street 1:558 REABA AVE
Mailing Address - Street 2:
Mailing Address - City:CONGERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:61729-9579
Mailing Address - Country:US
Mailing Address - Phone:309-706-0602
Mailing Address - Fax:
Practice Address - Street 1:1003 MARTIN LUTHER KING DR
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:IL
Practice Address - Zip Code:61701-1429
Practice Address - Country:US
Practice Address - Phone:309-820-3660
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-15
Last Update Date:2018-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180.008601101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional