Provider Demographics
NPI:1316383854
Name:SMITH, JILL CLAUDINE (LPC)
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:CLAUDINE
Last Name:SMITH
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:88 W COMMERCE DR
Mailing Address - Street 2:SUITE C
Mailing Address - City:HAYDEN
Mailing Address - State:ID
Mailing Address - Zip Code:83835-7994
Mailing Address - Country:US
Mailing Address - Phone:208-762-4405
Mailing Address - Fax:
Practice Address - Street 1:88 W COMMERCE DR
Practice Address - Street 2:SUITE C
Practice Address - City:HAYDEN
Practice Address - State:ID
Practice Address - Zip Code:83835-7994
Practice Address - Country:US
Practice Address - Phone:208-762-4405
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-05-10
Last Update Date:2013-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLPC-5193101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional