Provider Demographics
NPI:1770671034
Name:BRUE, JILL (LPC)
Entity Type:Individual
Prefix:MRS
First Name:JILL
Middle Name:
Last Name:BRUE
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:MRS
Other - First Name:JILL
Other - Middle Name:SMITH
Other - Last Name:BRUE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:9320 GREYHAWK RD
Mailing Address - Street 2:
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79119-7590
Mailing Address - Country:US
Mailing Address - Phone:806-367-5891
Mailing Address - Fax:
Practice Address - Street 1:9320 GREYHAWK RD
Practice Address - Street 2:
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79119-7590
Practice Address - Country:US
Practice Address - Phone:806-367-5891
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2011-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXLPC14191208421101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX113096505Medicaid
TX113096502Medicaid