Provider Demographics
NPI:1760623938
Name:CHIPMAN, JIL (MFT)
Entity Type:Individual
Prefix:MS
First Name:JIL
Middle Name:
Last Name:CHIPMAN
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:JIL
Other - Middle Name:CHIPMAN
Other - Last Name:MCDONOUGH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MFT
Mailing Address - Street 1:P.O. BOX 477
Mailing Address - Street 2:
Mailing Address - City:DOUGLAS CITY
Mailing Address - State:CA
Mailing Address - Zip Code:96024-0477
Mailing Address - Country:US
Mailing Address - Phone:530-355-3081
Mailing Address - Fax:
Practice Address - Street 1:65 MAIN STREET
Practice Address - Street 2:SUITE B
Practice Address - City:WEAVERVILLE
Practice Address - State:CA
Practice Address - Zip Code:96093
Practice Address - Country:US
Practice Address - Phone:530-355-3081
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-17
Last Update Date:2012-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC28958106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist