Provider Demographics
NPI:1073822508
Name:SHIRE, JILL COLLEEN (MA)
Entity Type:Individual
Prefix:MS
First Name:JILL
Middle Name:COLLEEN
Last Name:SHIRE
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 N ASH ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:CASPER
Mailing Address - State:WY
Mailing Address - Zip Code:82601-1821
Mailing Address - Country:US
Mailing Address - Phone:307-277-7802
Mailing Address - Fax:877-623-7006
Practice Address - Street 1:130 N ASH ST
Practice Address - Street 2:SUITE 201
Practice Address - City:CASPER
Practice Address - State:WY
Practice Address - Zip Code:82601-1821
Practice Address - Country:US
Practice Address - Phone:307-277-7802
Practice Address - Fax:877-623-7006
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-01
Last Update Date:2017-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYLPC 276101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor