Provider Demographics
NPI:1760598544
Name:STEVENS, JILL JOHNSON (LPC)
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:JOHNSON
Last Name:STEVENS
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:JILL
Other - Middle Name:KATHLEEN
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC
Mailing Address - Street 1:11338 HILLSIDE GLEN TRL
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77065-5026
Mailing Address - Country:US
Mailing Address - Phone:713-468-6100
Mailing Address - Fax:
Practice Address - Street 1:810 HIGHWAY 6 S STE 108
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77079-4010
Practice Address - Country:US
Practice Address - Phone:713-468-6100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX13154101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health