Provider Demographics
NPI:1295337848
Name:AZUMA, JILL SCHULSTAD (MA, APCC8807)
Entity type:Individual
Prefix:
First Name:JILL
Middle Name:SCHULSTAD
Last Name:AZUMA
Suffix:
Gender:F
Credentials:MA, APCC8807
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22431 ANTONIO PKWY STE B160
Mailing Address - Street 2:
Mailing Address - City:RCHO STA MARG
Mailing Address - State:CA
Mailing Address - Zip Code:92688-3932
Mailing Address - Country:US
Mailing Address - Phone:214-766-7979
Mailing Address - Fax:
Practice Address - Street 1:1225 W 6TH ST
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92703-2101
Practice Address - Country:US
Practice Address - Phone:714-972-1402
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-09
Last Update Date:2020-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA8807101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health