Provider Demographics
NPI:1033440698
Name:WATSON, JILL ANN (LPC, CTT)
Entity Type:Individual
Prefix:MRS
First Name:JILL
Middle Name:ANN
Last Name:WATSON
Suffix:
Gender:F
Credentials:LPC, CTT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 534
Mailing Address - Street 2:
Mailing Address - City:NEW PHILADELPHIA
Mailing Address - State:OH
Mailing Address - Zip Code:44663-0534
Mailing Address - Country:US
Mailing Address - Phone:330-343-7400
Mailing Address - Fax:330-343-7414
Practice Address - Street 1:547 1/2 S JAMES ST
Practice Address - Street 2:STE. A
Practice Address - City:DOVER
Practice Address - State:OH
Practice Address - Zip Code:44622-2137
Practice Address - Country:US
Practice Address - Phone:330-343-7400
Practice Address - Fax:330-343-7414
Is Sole Proprietor?:No
Enumeration Date:2010-01-21
Last Update Date:2016-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHC.0900192101YM0800X
OHC.0900192-TEMP101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH3065883Medicaid