Provider Demographics
NPI:1851902084
Name:CROSBY, JILL (MSW)
Entity Type:Individual
Prefix:MS
First Name:JILL
Middle Name:
Last Name:CROSBY
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:MS
Other - First Name:JILL
Other - Middle Name:
Other - Last Name:CROSBY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MSW
Mailing Address - Street 1:3502 JENKS AVE APT 3104
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32405-0408
Mailing Address - Country:US
Mailing Address - Phone:931-801-3175
Mailing Address - Fax:
Practice Address - Street 1:10611 NW STATE ROAD 20
Practice Address - Street 2:
Practice Address - City:BRISTOL
Practice Address - State:FL
Practice Address - Zip Code:32321-3441
Practice Address - Country:US
Practice Address - Phone:850-643-1033
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-11
Last Update Date:2020-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty