Doctor Name: | MRS. JILL MARIE KILLEEN |
NPI Number: | 1386737302 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | MA, LPC |
License Number: | LPC10799 |
Business Practice Address: | 1326 W Highway 92 Ste J Bisbee, AZ - 856031151 |
Business Phone Number: | 5204327751 |
Business Fax Number: | 5204323695 |
Mailing Address: | 489 N Arroyo Blvd, NOGALES |
State: | AZ |
Postal Code: | 856212644 |
Phone Number: | 5202874713 |
Fax Number: | 5202879794 |
NPI Enumeration Date: | 10/02/2006 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YP2500X |
License Number: | LPC10799 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | AZ |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Professional |
Taxonomy Definition: |