Provider Demographics
NPI:1033395876
Name:MITCHELL, JILL (PHD)
Entity Type:Individual
Prefix:DR
First Name:JILL
Middle Name:
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1159 E IRON EAGLE DR
Mailing Address - Street 2:SUITE 170-F
Mailing Address - City:EAGLE
Mailing Address - State:ID
Mailing Address - Zip Code:83616-6871
Mailing Address - Country:US
Mailing Address - Phone:208-939-0338
Mailing Address - Fax:208-321-4130
Practice Address - Street 1:1159 E IRON EAGLE DR
Practice Address - Street 2:SUITE 170-F
Practice Address - City:EAGLE
Practice Address - State:ID
Practice Address - Zip Code:83616-6871
Practice Address - Country:US
Practice Address - Phone:208-939-0338
Practice Address - Fax:208-321-4130
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-10
Last Update Date:2008-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLMFT-12106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist