Provider Demographics
NPI:1033280474
Name:OTT, JILL M (LMHC)
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:M
Last Name:OTT
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11689 MARLA LN
Mailing Address - Street 2:
Mailing Address - City:SEMINOLE
Mailing Address - State:FL
Mailing Address - Zip Code:33772-2215
Mailing Address - Country:US
Mailing Address - Phone:727-644-4524
Mailing Address - Fax:727-399-3615
Practice Address - Street 1:13575 58TH ST N
Practice Address - Street 2:SUITE 177
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33760-3740
Practice Address - Country:US
Practice Address - Phone:727-644-4524
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH 8291101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health