Provider Demographics
NPI:1487044277
Name:LEE, JILL A (MA, NCC, LPC)
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:A
Last Name:LEE
Suffix:
Gender:F
Credentials:MA, NCC, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:797 DURHAM DR
Mailing Address - Street 2:
Mailing Address - City:CANYON LAKE
Mailing Address - State:TX
Mailing Address - Zip Code:78133-5566
Mailing Address - Country:US
Mailing Address - Phone:830-266-9240
Mailing Address - Fax:830-310-6039
Practice Address - Street 1:468 S SEGUIN AVE STE 201
Practice Address - Street 2:
Practice Address - City:NEW BRAUNFELS
Practice Address - State:TX
Practice Address - Zip Code:78130-7670
Practice Address - Country:US
Practice Address - Phone:830-266-9240
Practice Address - Fax:830-310-6039
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-31
Last Update Date:2021-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX73196101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health