Provider Demographics
NPI:1679908685
Name:IRWIN, JILLIAN (LMFT)
Entity Type:Individual
Prefix:
First Name:JILLIAN
Middle Name:
Last Name:IRWIN
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 1:3910 S RURAL RD
Mailing Address - Street 2:SUITE J
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85282-5581
Mailing Address - Country:US
Mailing Address - Phone:480-317-9868
Mailing Address - Fax:480-317-9867
Practice Address - Street 1:8705 E MCDOWELL RD
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85257-3909
Practice Address - Country:US
Practice Address - Phone:480-882-4545
Practice Address - Fax:480-946-6997
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-09
Last Update Date:2023-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106H00000X
AZLMFT-15682106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ130590Medicaid