Provider Demographics
NPI:1558819763
Name:GROVES, JILL E (LMFT)
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:E
Last Name:GROVES
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24050 MADISON ST STE 215
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90505-6017
Mailing Address - Country:US
Mailing Address - Phone:310-956-4606
Mailing Address - Fax:310-940-2329
Practice Address - Street 1:24050 MADISON ST STE 215
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90505-6017
Practice Address - Country:US
Practice Address - Phone:310-956-4606
Practice Address - Fax:310-940-2329
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-16
Last Update Date:2016-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA51515106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist