MEDICARE: MR. JACK L HILEMAN LMFT

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	106H00000X	Marriage & Family Therapist	1091	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1588721997
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JACK L HILEMAN LMFT

Provider Business Mailing Address
First Line	:	1451 S ELM EUGENE ST UNIT 54
Second Line	:
City	:	GREENSBORO
State	:	NC
Zip	:	27406-2392
Country	:	US
Telephone Number	:	336-202-0846
Fax Number	:	866-420-9205

Provider Business Practice Location Address
First Line	:	1451 S ELM EUGENE ST
Second Line	:
City	:	GREENSBORO
State	:	NC
Zip	:	27406-2200
Country	:	US
Telephone Number	:	336-202-0846
Fax Number	:	866-420-9205

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/03/2007
Last Update Date	:	06/24/2019

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Directions to “ MR. JACK L HILEMAN LMFT” Practice Location

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