Provider Demographics
NPI:1275275315
Name:KOMURA, JILL M (LMHCA)
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:M
Last Name:KOMURA
Suffix:
Gender:F
Credentials:LMHCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 7307
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98507-7307
Mailing Address - Country:US
Mailing Address - Phone:360-539-1230
Mailing Address - Fax:
Practice Address - Street 1:203 4TH AVE E STE 221
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98501-1187
Practice Address - Country:US
Practice Address - Phone:360-539-1230
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-09
Last Update Date:2022-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60861950101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health