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General NPI Number Information
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NPI Number | 1265947691
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Entity Type | Organization
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Legal Business Name | DR. JILL, ORG PSYCHOLOGICAL SERVICES LLC
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Dates
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Enumeration Date | 12/07/2017
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Last Update Date | 12/07/2017
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Provider Practice Location Address
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Address Line | 13021 PRESTWICK DR
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City | RIVERVIEW
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State | FL
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Zip | 33579-7047
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Country | US
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Telephone | 813-955-1602
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Fax |
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Provider Business Mailing Address
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Address Line | 13021 PRESTWICK DR
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City | RIVERVIEW
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State | FL
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Zip | 33579-7047
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Country | US
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Telephone | 813-955-1602
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Fax |
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Authorized Official
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Title or Position | OWNER/PSYCHOTHERAPIST
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Name | DR. JILL MARION HINEGARDNER
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Credential | PHD, LMHC
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Telephone | 813-708-9977
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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 | MH9718
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License Number State | FL
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