Provider Demographics
NPI:1447737283
Name:LEE, JILLIAN MONET (LCSW)
Entity Type:Individual
Prefix:
First Name:JILLIAN
Middle Name:MONET
Last Name:LEE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 E 10TH AVE STE 330
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97401-3357
Mailing Address - Country:US
Mailing Address - Phone:541-868-2004
Mailing Address - Fax:
Practice Address - Street 1:401 E 10TH AVE STE 330
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-3357
Practice Address - Country:US
Practice Address - Phone:541-868-2004
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-24
Last Update Date:2018-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORL77421041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical