Healthcare Provider Details

I. General information

NPI: 1659237253
Provider Name (Legal Business Name): JILLIAN MINIX
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/29/2025
Last Update Date: 12/29/2025
Certification Date: 12/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1405 CHEWS LANDING RD STE 23
CLEMENTON NJ
08021-2769
US

IV. Provider business mailing address

PO BOX 34
GRENLOCH NJ
08032-0034
US

V. Phone/Fax

Practice location:
  • Phone: 856-441-2229
  • Fax:
Mailing address:
  • Phone: 856-357-6407
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number37LC00387600
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number37AC00828100
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: