MEDICARE: MRS. JILL S OATEY LPC LSW

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	C0005578	OH
2	101YP2500X	Professional Counselor	S0021089	OH
3	106H00000X	Marriage & Family Therapist	C0005578	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	889300	OTHER		GREAT WEST ONE HEALTH PLA

General Provider Information

NPI Number	:	1720009442
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JILL S OATEY LPC LSW

Provider Business Mailing Address
First Line	:	31571 SCHWARTZ RD
Second Line	:
City	:	WESTLAKE
State	:	OH
Zip	:	44145-3760
Country	:	US
Telephone Number	:	440-892-0452
Fax Number	:	440-892-3472

Provider Business Practice Location Address
First Line	:	24551 DETROIT RD
Second Line	:	STE 5
City	:	WESTLAKE
State	:	OH
Zip	:	44145-2592
Country	:	US
Telephone Number	:	440-892-0452
Fax Number	:	440-892-3472

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

Provider Enumeration Date	:	07/21/2006
Last Update Date	:	09/11/2025

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