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General NPI Number Information
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NPI Number | 1306493325
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Entity Type | Individual
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Provider Name | JILL S MACON LPC, LCPC
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Gender | Female
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Dates
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Enumeration Date | 08/23/2019
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Last Update Date | 02/12/2024
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Provider Practice Location Address
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Address Line | 556 S BELMONT ST
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City | WICHITA
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State | KS
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Zip | 67218-2202
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Country | US
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Telephone | 405-590-2974
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Fax | 888-964-2524
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Provider Business Mailing Address
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Address Line | 556 S BELMONT ST
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City | WICHITA
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State | KS
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Zip | 67218-2202
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Country | US
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Telephone | 405-590-2974
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Fax | 888-964-2524
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 11278
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License Number State | OK
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 03528
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License Number State | KS
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