Provider Demographics
NPI:1336333194
Name:HILDRE, JEROLD LEE (MS, LPC)
Entity Type:Individual
Prefix:MR
First Name:JEROLD
Middle Name:LEE
Last Name:HILDRE
Suffix:
Gender:M
Credentials:MS, LPC
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 260602
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75026-0602
Mailing Address - Country:US
Mailing Address - Phone:214-726-5451
Mailing Address - Fax:469-362-6490
Practice Address - Street 1:9300 COIT RD
Practice Address - Street 2:1424
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75025-4481
Practice Address - Country:US
Practice Address - Phone:214-726-5451
Practice Address - Fax:469-362-6490
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-04
Last Update Date:2007-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX16114101YP2500X
IL18599171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No171M00000XOther Service ProvidersCase Manager/Care Coordinator