Provider Demographics
NPI:1184753378
Name:DILI, JEAN (BC-DMT, LISAC, LPC)
Entity type:Individual
Prefix:
First Name:JEAN
Middle Name:
Last Name:DILI
Suffix:
Gender:F
Credentials:BC-DMT, LISAC, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:285 N BROAD ST
Mailing Address - Street 2:
Mailing Address - City:GLOBE
Mailing Address - State:AZ
Mailing Address - Zip Code:85501-2503
Mailing Address - Country:US
Mailing Address - Phone:928-961-4774
Mailing Address - Fax:
Practice Address - Street 1:285 N BROAD ST
Practice Address - Street 2:
Practice Address - City:GLOBE
Practice Address - State:AZ
Practice Address - Zip Code:85501-2503
Practice Address - Country:US
Practice Address - Phone:928-961-4774
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-05
Last Update Date:2021-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ11693101YA0400X
AZ106105101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ11693OtherSTATE SUB ABUSE LICENSE
AZ106105OtherSTATE MH LICENSE