Provider Demographics
NPI:1205091790
Name:DEMOS, JILL NONE (PSYD)
Entity type:Individual
Prefix:MRS
First Name:JILL
Middle Name:NONE
Last Name:DEMOS
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 279
Mailing Address - Street 2:
Mailing Address - City:PERRIS
Mailing Address - State:CA
Mailing Address - Zip Code:92572-0279
Mailing Address - Country:US
Mailing Address - Phone:951-657-4096
Mailing Address - Fax:951-657-8710
Practice Address - Street 1:24050 CHRISTMAS TREE LANE
Practice Address - Street 2:
Practice Address - City:PERRIS
Practice Address - State:CA
Practice Address - Zip Code:92570
Practice Address - Country:US
Practice Address - Phone:951-657-4096
Practice Address - Fax:951-657-8710
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-23
Last Update Date:2008-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 15732101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health