MEDICARE: JILL SHEALY COUNSELING LLC

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
1	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1366309387
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JILL SHEALY COUNSELING LLC

Provider Business Mailing Address
First Line	:	7029 N WALL AVE
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97203-5151
Country	:	US
Telephone Number	:	503-208-4049
Fax Number	:

Provider Business Practice Location Address
First Line	:	7029 N WALL AVE
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97203-5151
Country	:	US
Telephone Number	:	503-208-4049
Fax Number	:

Authorized Official
Title or Position	:	OWNER AND THERAPIST
Name	:	JILL SHEALY
Credential	:	LPC
Telephone Number	:	503-208-4049

Provider Enumeration Date	:	01/09/2026
Last Update Date	:	01/20/2026

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