Provider Demographics
NPI:1376205344
Name:FREEMAN, JILLIAN COLETTE
Entity Type:Individual
Prefix:MRS
First Name:JILLIAN
Middle Name:COLETTE
Last Name:FREEMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1734 W SHAW AVE
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93711-3486
Mailing Address - Country:US
Mailing Address - Phone:559-439-2647
Mailing Address - Fax:559-439-2214
Practice Address - Street 1:1734 W SHAW AVE
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93711-3486
Practice Address - Country:US
Practice Address - Phone:559-439-2647
Practice Address - Fax:559-439-2214
Is Sole Proprietor?:No
Enumeration Date:2021-10-07
Last Update Date:2021-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAMFT127118101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health