Provider Demographics
NPI:1124409404
Name:BERNIS, JILL T (LPC, NCC)
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:T
Last Name:BERNIS
Suffix:
Gender:F
Credentials:LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6510 S WESTERN BLDG #400
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73139-1712
Mailing Address - Country:US
Mailing Address - Phone:405-634-1111
Mailing Address - Fax:405-634-1122
Practice Address - Street 1:6510 S WESTERN BLDG #400
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73139-1712
Practice Address - Country:US
Practice Address - Phone:405-634-1111
Practice Address - Fax:405-634-1122
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-12
Last Update Date:2015-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK4089101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
214699OtherNATIONAL CERTIFIED COUNSELORS