Provider Demographics
NPI:1245667633
Name:DAMRON, JILLIAN ELISE HOLTZ (MA, LPCC)
Entity type:Individual
Prefix:MRS
First Name:JILLIAN
Middle Name:ELISE HOLTZ
Last Name:DAMRON
Suffix:
Gender:F
Credentials:MA, LPCC
Other - Prefix:
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Mailing Address - Street 1:8170 33RD AVE
Mailing Address - Street 2:MS 21110Q
Mailing Address - City:BLOOMINGTON
Mailing Address - State:MN
Mailing Address - Zip Code:55425-4516
Mailing Address - Country:US
Mailing Address - Phone:651-552-2600
Mailing Address - Fax:651-552-2614
Practice Address - Street 1:5625 CENEX DR
Practice Address - Street 2:
Practice Address - City:INVER GROVE HEIGHTS
Practice Address - State:MN
Practice Address - Zip Code:55077-1724
Practice Address - Country:US
Practice Address - Phone:651-552-2600
Practice Address - Fax:651-552-2614
Is Sole Proprietor?:No
Enumeration Date:2013-10-01
Last Update Date:2019-05-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WI1898226101YP2500X
MN01738101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional