Healthcare Provider Details

I. General information

NPI: 1497474001
Provider Name (Legal Business Name): JASON MARAVELIAS LCPC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/25/2022
Last Update Date: 08/12/2025
Certification Date: 08/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

763 S ALDRIDGE LN
ROUND LAKE IL
60073-4244
US

IV. Provider business mailing address

763 S ALDRIDGE LN
ROUND LAKE IL
60073-4244
US

V. Phone/Fax

Practice location:
  • Phone: 224-908-4199
  • Fax:
Mailing address:
  • Phone: 224-908-4199
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number180017200
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: