Provider Demographics
NPI:1619319878
Name:THERRIEN, JILL KATHERINE (MA, MFT)
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:KATHERINE
Last Name:THERRIEN
Suffix:
Gender:F
Credentials:MA, MFT
Other - Prefix:
Other - First Name:JILL
Other - Middle Name:
Other - Last Name:RINGLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:619 CAMPBELL AVE
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49006-3008
Mailing Address - Country:US
Mailing Address - Phone:510-421-6400
Mailing Address - Fax:
Practice Address - Street 1:4341 S WESTNEDGE AVE STE 2212
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49008-3287
Practice Address - Country:US
Practice Address - Phone:510-421-6400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-29
Last Update Date:2024-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA110300106H00000X
MI4101007422106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist