Provider Demographics
NPI:1598100158
Name:STEWART, JILL (LPC)
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:
Last Name:STEWART
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 1:1674 W HILL RD
Mailing Address - Street 2:SUITE 12
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83702-0958
Mailing Address - Country:US
Mailing Address - Phone:208-340-2052
Mailing Address - Fax:
Practice Address - Street 1:1674 W HILL RD
Practice Address - Street 2:SUITE 12
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83702-0958
Practice Address - Country:US
Practice Address - Phone:208-340-2052
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-08
Last Update Date:2013-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLPC-5015101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor