Provider Demographics
NPI:1336210855
Name:SIBERT-MELANCON, JILL LOUISE (MA, MFT, LADC)
Entity Type:Individual
Prefix:MS
First Name:JILL
Middle Name:LOUISE
Last Name:SIBERT-MELANCON
Suffix:
Gender:F
Credentials:MA, MFT, LADC
Other - Prefix:MS
Other - First Name:JILL
Other - Middle Name:LOUISE
Other - Last Name:SIBERT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, MFT, LADC
Mailing Address - Street 1:7620 RACEL ST
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89131-1624
Mailing Address - Country:US
Mailing Address - Phone:702-645-0438
Mailing Address - Fax:
Practice Address - Street 1:6171 W CHARLESTON BLVD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89146-1126
Practice Address - Country:US
Practice Address - Phone:702-486-7629
Practice Address - Fax:702-486-8029
Is Sole Proprietor?:No
Enumeration Date:2006-11-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV0743106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist