Provider Demographics
NPI:1548801475
Name:BEDELL, JILL ASHLEY (LPC)
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:ASHLEY
Last Name:BEDELL
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:PO BOX 4052
Mailing Address - Street 2:
Mailing Address - City:NORTH MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29597-4052
Mailing Address - Country:US
Mailing Address - Phone:843-384-1482
Mailing Address - Fax:
Practice Address - Street 1:106 LANSFORD PL STE 202
Practice Address - Street 2:
Practice Address - City:MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29588-6979
Practice Address - Country:US
Practice Address - Phone:843-213-2659
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-02
Last Update Date:2021-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC7850101YM0800X, 101YP2500X
SC6635101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health