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JARED G DEERHAKE BS MHP
NPI 1790135796
Counselor in Centralia, IL

Active since June 21, 2016
904 E. MARTIN LUTHER KING DR., CENTRALIA, IL 62801(618) 533-1391 Get Directions Write a Review

NPPES record last updated: June 21, 2016. Verified against the NPPES registry weekly; last sync: August 16, 2026.

About Jared G Deerhake Bs Mhp NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

JARED G DEERHAKE BS MHP (NPI 1790135796) is an individual counselor in Centralia, Illinois and active in the NPI registry since June 2016.

NPPES Registry Identity

NPI1790135796
Entity TypeIndividualMale
Primary Taxonomy101Y00000X
Provider Legal NameJARED G DEERHAKECredential: BS MHP
Location Address904 E. MARTIN LUTHER KING DR.Centralia, IL 62801-3058
Mailing Address904 E. Martin Luther King Dr.Centralia, IL 62801-3058
Phone(618) 533-1391
Sole ProprietorNo
Enumeration DateJune 21, 2016
✔ NPI 1790135796 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyCounselorBehavioral Health & Social Service Providers
Taxonomy Code101Y00000X
Definition
A provider who is trained and educated in the performance of behavior health services through interpersonal communications and analysis. Training and education at the specialty level usually requires a master's degree and clinical experience and supervision for licensure or certification.
904 E. MARTIN LUTHER KING DR., Centralia, IL 62801
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Other Identifiers 1

Medicaid370915481007IL

Other Providers at the Same Location NPPES 3

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

MS. SALLY JOHONNA LINDSAY LCSW
Social Worker (Clinical)
904 E. MARTIN LUTHER KING DR.
CENTRALIA, IL 62801
Marion County (618) 533-1391
MR. COLEMAN RILEY VIZCARRA
Counselor (Mental Health)
904 E. MARTIN LUTHER KING DR.
CENTRALIA, IL 62801
Marion County (618) 533-1391
AARON DAVIS LCSW
Social Worker (Clinical)
904 E. MARTIN LUTHER KING DR.
CENTRALIA, IL 62801
Marion County (618) 533-1391

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Jared Deerhake's NPI number?

The NPI number for Jared Deerhake is 1790135796. It was assigned to this individual provider in the NPPES registry on June 21, 2016.

Where is Jared Deerhake located?

Jared Deerhake practices at 904 E. Martin Luther King Dr., Centralia, IL 62801. The listed phone number is (618) 533-1391.

What is Jared Deerhake's specialty?

The primary specialty registered for this NPI is Counselor with taxonomy code 101Y00000X.

When was this NPI record last updated?

The NPPES record for Jared Deerhake was last updated on June 21, 2016. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 10 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.