Provider Demographics
NPI:1619215639
Name:MORELL, JILL LAURA (LLPC)
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:LAURA
Last Name:MORELL
Suffix:
Gender:F
Credentials:LLPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:234 1/2 WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:GRAND HAVEN
Mailing Address - State:MI
Mailing Address - Zip Code:49417-3307
Mailing Address - Country:US
Mailing Address - Phone:616-607-4476
Mailing Address - Fax:616-935-7177
Practice Address - Street 1:234 1/2 WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:GRAND HAVEN
Practice Address - State:MI
Practice Address - Zip Code:49417-3307
Practice Address - Country:US
Practice Address - Phone:616-607-4476
Practice Address - Fax:616-935-7177
Is Sole Proprietor?:No
Enumeration Date:2013-01-25
Last Update Date:2013-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401012399101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor