Provider Demographics
NPI:1407113426
Name:VALLIERE, JILL MARIE (LPC)
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:MARIE
Last Name:VALLIERE
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 1:5 W MAIN ST UNIT 3
Mailing Address - Street 2:
Mailing Address - City:BOYNE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49712-3700
Mailing Address - Country:US
Mailing Address - Phone:231-881-5001
Mailing Address - Fax:231-344-6100
Practice Address - Street 1:559 S M 75
Practice Address - Street 2:
Practice Address - City:BOYNE CITY
Practice Address - State:MI
Practice Address - Zip Code:49712-8842
Practice Address - Country:US
Practice Address - Phone:231-881-5001
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-15
Last Update Date:2023-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401013209101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health