Provider Demographics
NPI:1437510518
Name:FAIRLESS, JILL (PHD)
Entity Type:Individual
Prefix:DR
First Name:JILL
Middle Name:
Last Name:FAIRLESS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:JILL
Other - Middle Name:
Other - Last Name:SUTTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:4001 SW 13TH ST
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32608-3513
Mailing Address - Country:US
Mailing Address - Phone:352-265-9623
Mailing Address - Fax:
Practice Address - Street 1:4001 SW 13TH ST
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32608-3513
Practice Address - Country:US
Practice Address - Phone:352-265-9623
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-03-16
Last Update Date:2023-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY9469103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical