MEDICARE: JILL G. CHRISMAN PH.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC1900X	Counseling Psychologist	33979	TX

General Provider Information

NPI Number	:	1134131014
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JILL G. CHRISMAN PH.D.

Provider Business Mailing Address
First Line	:	10110 ECHORIDGE DR
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78750-4001
Country	:	US
Telephone Number	:	512-797-0795
Fax Number	:

Provider Business Practice Location Address
First Line	:	604B W 9TH ST
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78701-2212
Country	:	US
Telephone Number	:	512-797-0795
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/12/2006
Last Update Date	:	03/26/2009

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