Provider Demographics
NPI:1245338466
Name:RILEY, JILL L (LPC)
Entity type:Individual
Prefix:
First Name:JILL
Middle Name:L
Last Name:RILEY
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2910 N POWERS BLVD # 305
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80922-2801
Mailing Address - Country:US
Mailing Address - Phone:719-337-9696
Mailing Address - Fax:197-362-4253
Practice Address - Street 1:5473 S BUCKSKIN PASS DR
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80917-2762
Practice Address - Country:US
Practice Address - Phone:719-391-9991
Practice Address - Fax:719-391-9990
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2024-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1839101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional