Provider Demographics
NPI:1962835561
Name:WALKER, JILLIAN MICHELLE (MA, LPCC)
Entity Type:Individual
Prefix:
First Name:JILLIAN
Middle Name:MICHELLE
Last Name:WALKER
Suffix:
Gender:F
Credentials:MA, LPCC
Other - Prefix:
Other - First Name:JILLIAN
Other - Middle Name:MICHELLE
Other - Last Name:CASTELLANO, TORABPOUR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 161462
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55816-1462
Mailing Address - Country:US
Mailing Address - Phone:774-219-2156
Mailing Address - Fax:
Practice Address - Street 1:525 S LAKE AVE STE 325
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:MN
Practice Address - Zip Code:55802-2368
Practice Address - Country:US
Practice Address - Phone:208-576-5757
Practice Address - Fax:844-576-5756
Is Sole Proprietor?:No
Enumeration Date:2013-08-19
Last Update Date:2023-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT64326101YP2500X
MN3698101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional