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General NPI Number Information
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NPI Number | 1023462363
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Entity Type | Organization
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Legal Business Name | JILLIAN FAULKNER COUNSELING SERVICES LLC
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Dates
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Enumeration Date | 04/22/2016
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Last Update Date | 04/22/2016
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Provider Practice Location Address
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Address Line | 2100 N BROADWAY AVE
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City | ADA
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State | OK
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Zip | 74820-1048
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Country | US
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Telephone | 580-310-4336
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Fax |
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Provider Business Mailing Address
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Address Line | 2100 N BROADWAY AVE
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City | ADA
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State | OK
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Zip | 74820-1048
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | JILLIAN FAULKNER
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Credential | LPC
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Telephone | 580-310-4336
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 5324
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License Number State | OK
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