Provider Demographics
NPI:1023034816
Name:BRENNER, JILL ZELIGSON (LCSW)
Entity Type:Individual
Prefix:MISS
First Name:JILL
Middle Name:ZELIGSON
Last Name:BRENNER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10816 ENCLAVE VISTA CV
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78730-1527
Mailing Address - Country:US
Mailing Address - Phone:512-653-9205
Mailing Address - Fax:
Practice Address - Street 1:1000 WESTBANK DR
Practice Address - Street 2:SUITE 6-250
Practice Address - City:WEST LAKE HILLS
Practice Address - State:TX
Practice Address - Zip Code:78746-6598
Practice Address - Country:US
Practice Address - Phone:512-653-9205
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-14
Last Update Date:2012-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX411981041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical