Healthcare Provider Details

I. General information

NPI: 1376113076
Provider Name (Legal Business Name): JILL RENE' CIONE LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/25/2021
Last Update Date: 06/25/2021
Certification Date: 06/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1701 N COLLINS BLVD STE 235
RICHARDSON TX
75080-3553
US

IV. Provider business mailing address

1701 N COLLINS BLVD STE 235
RICHARDSON TX
75080-3553
US

V. Phone/Fax

Practice location:
  • Phone: 972-742-5704
  • Fax:
Mailing address:
  • Phone: 972-742-5704
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number74814
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: