Provider Demographics
NPI:1073707089
Name:AMOS, JILL STALHEBER (LMHC)
Entity Type:Individual
Prefix:MRS
First Name:JILL
Middle Name:STALHEBER
Last Name:AMOS
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 1:3740 20TH ST
Mailing Address - Street 2:
Mailing Address - City:VERO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32960-2418
Mailing Address - Country:US
Mailing Address - Phone:772-643-1740
Mailing Address - Fax:772-562-2111
Practice Address - Street 1:3740 20TH ST STE B
Practice Address - Street 2:
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32960-2418
Practice Address - Country:US
Practice Address - Phone:772-643-1740
Practice Address - Fax:772-562-2111
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-03
Last Update Date:2014-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH5647101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health