Provider Demographics
NPI:1164733275
Name:HAIRE, JILL (MA, LMHC)
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:
Last Name:HAIRE
Suffix:
Gender:F
Credentials:MA, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7618 PISSARRO DR APT 308
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32819-7352
Mailing Address - Country:US
Mailing Address - Phone:407-340-6074
Mailing Address - Fax:407-210-3901
Practice Address - Street 1:4700 MILLENIA LAKES BLVD.
Practice Address - Street 2:SUITE 175
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32839-6015
Practice Address - Country:US
Practice Address - Phone:407-340-6074
Practice Address - Fax:407-210-3901
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-24
Last Update Date:2010-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL222315101Y00000X
FL4016101YA0400X
FLMH8833101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)