Provider Demographics
NPI:1902183718
Name:TEBBE, JILLIAN L (LCSW)
Entity Type:Individual
Prefix:
First Name:JILLIAN
Middle Name:L
Last Name:TEBBE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:JILLIAN
Other - Middle Name:L
Other - Last Name:EVANS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW
Mailing Address - Street 1:390 ERIE AVE
Mailing Address - Street 2:
Mailing Address - City:CONNERSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47331-3177
Mailing Address - Country:US
Mailing Address - Phone:765-825-4124
Mailing Address - Fax:765-825-3649
Practice Address - Street 1:390 ERIE AVE
Practice Address - Street 2:
Practice Address - City:CONNERSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47331-3177
Practice Address - Country:US
Practice Address - Phone:765-825-4124
Practice Address - Fax:765-825-3649
Is Sole Proprietor?:No
Enumeration Date:2011-11-08
Last Update Date:2019-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34008502A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical