Provider Demographics
NPI:1851404990
Name:VILIM, JEANNE MARIE (M ED, LPC)
Entity Type:Individual
Prefix:MS
First Name:JEANNE
Middle Name:MARIE
Last Name:VILIM
Suffix:
Gender:F
Credentials:M ED, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4101 PARKSTONE HEIGHTS DR STE 260
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78746-7397
Mailing Address - Country:US
Mailing Address - Phone:512-789-3860
Mailing Address - Fax:512-306-8086
Practice Address - Street 1:4101 PARKSTONE HEIGHTS DR STE 260
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78746-7397
Practice Address - Country:US
Practice Address - Phone:512-789-3860
Practice Address - Fax:512-306-8086
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX13834101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX6419LCOtherBC / BS