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NPI Code Detail

MEDICARE: JILL HAIRE M.A., L.M.H.C.

MEDICARE: JILL HAIRE M.A., L.M.H.C.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101Y00000XCounselor222315FL
2101YA0400XAddiction (Substance Use Disorder) Counselor4016FL
3101YM0800XMental Health CounselorMH8833FL

General Provider Information

NPI Number : 1164733275
Entity Type Code : Individual
Provider Name (Legal Business Name) : JILL HAIRE M.A., L.M.H.C.
Provider Business Mailing Address
First Line : 7618 PISSARRO DR APT 308
Second Line :
City : ORLANDO
State : FL
Zip : 32819-7352
Country : US
Telephone Number : 407-340-6074
Fax Number : 407-210-3901
Provider Business Practice Location Address
First Line : 4700 MILLENIA LAKES BLVD.
Second Line : SUITE 175
City : ORLANDO
State : FL
Zip : 32839-6015
Country : US
Telephone Number : 407-340-6074
Fax Number : 407-210-3901
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/24/2010
Last Update Date : 06/24/2010

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