Provider Demographics
NPI:1003827452
Name:CHRISTOPHER, JILL AMBER (PSYD, HSPP)
Entity Type:Individual
Prefix:DR
First Name:JILL
Middle Name:AMBER
Last Name:CHRISTOPHER
Suffix:
Gender:F
Credentials:PSYD, HSPP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:415 S WALNUT ST
Mailing Address - Street 2:SUITE 215
Mailing Address - City:SEYMOUR
Mailing Address - State:IN
Mailing Address - Zip Code:47274-2991
Mailing Address - Country:US
Mailing Address - Phone:812-523-0386
Mailing Address - Fax:812-523-8416
Practice Address - Street 1:415 S WALNUT ST
Practice Address - Street 2:SUITE 215
Practice Address - City:SEYMOUR
Practice Address - State:IN
Practice Address - Zip Code:47274-2991
Practice Address - Country:US
Practice Address - Phone:812-523-0386
Practice Address - Fax:812-523-8416
Is Sole Proprietor?:No
Enumeration Date:2006-08-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN20041655A103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical