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General NPI Number Information
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NPI Number | 1588131726
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Entity Type | Individual
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Provider Name | JILLIAN THERESA KINNEY MS
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Gender | Female
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Dates
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Enumeration Date | 10/25/2018
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Last Update Date | 04/24/2019
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Provider Practice Location Address
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Address Line | 2188 58TH ST N
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City | CLEARWATER
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State | FL
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Zip | 33760-3112
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Country | US
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Telephone | 903-794-2705
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Fax | 903-793-1203
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Provider Business Mailing Address
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Address Line | 4024 CENTRAL AVE
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City | ST PETERSBURG
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State | FL
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Zip | 33711-1239
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Country | US
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Telephone | 727-535-9811
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Fax | 903-793-1203
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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 | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number | RBT-18-56214
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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