Provider Demographics
NPI:1720584865
Name:HILL, JEFFREY ALAN (LPC)
Entity Type:Individual
Prefix:MR
First Name:JEFFREY
Middle Name:ALAN
Last Name:HILL
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12290 W EDGERTON AVE
Mailing Address - Street 2:
Mailing Address - City:HALES CORNERS
Mailing Address - State:WI
Mailing Address - Zip Code:53130-1029
Mailing Address - Country:US
Mailing Address - Phone:414-232-1178
Mailing Address - Fax:
Practice Address - Street 1:1933 W GRANGE AVE
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53221-4363
Practice Address - Country:US
Practice Address - Phone:414-282-8680
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-05
Last Update Date:2018-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI6868-125101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor