=====================================================
General NPI Number Information
=====================================================
NPI Number | 1043337553
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JILL N CHANEY LPC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/22/2007
-----------------------------------------------------
Last Update Date | 12/30/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 125 DONS WAY
-----------------------------------------------------
City | HOT SPRINGS
-----------------------------------------------------
State | AR
-----------------------------------------------------
Zip | 71913
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 501-624-7111
-----------------------------------------------------
Fax | 501-620-5109
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 125 DONS WAY
-----------------------------------------------------
City | HOT SPRINGS
-----------------------------------------------------
State | AR
-----------------------------------------------------
Zip | 71913-3908
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 501-620-5130
-----------------------------------------------------
Fax | 501-620-5109
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YP2500X
-----------------------------------------------------
Taxonomy Name | Professional Counselor
-----------------------------------------------------
License Number | P0708046
-----------------------------------------------------
License Number State | AR
-----------------------------------------------------