Provider Demographics
NPI:1174643266
Name:CASEBOLT, JILL MEREDITH JOANIS (MA - LMHC)
Entity Type:Individual
Prefix:MRS
First Name:JILL
Middle Name:MEREDITH JOANIS
Last Name:CASEBOLT
Suffix:
Gender:F
Credentials:MA - LMHC
Other - Prefix:MS
Other - First Name:JILL
Other - Middle Name:MEREDITH
Other - Last Name:JOANIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA - LMHC
Mailing Address - Street 1:108 20TH AVE SW
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98501
Mailing Address - Country:US
Mailing Address - Phone:360-339-2253
Mailing Address - Fax:
Practice Address - Street 1:120 STATE AVE NE
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98501
Practice Address - Country:US
Practice Address - Phone:360-339-2253
Practice Address - Fax:253-620-5013
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-30
Last Update Date:2020-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARC00051153101YM0800X
WALH60087706101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health