Provider Demographics
NPI:1336336924
Name:PACKMAN, JILL (PHD, MFT)
Entity Type:Individual
Prefix:DR
First Name:JILL
Middle Name:
Last Name:PACKMAN
Suffix:
Gender:F
Credentials:PHD, MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5150 CONVAIR DR
Mailing Address - Street 2:
Mailing Address - City:CARSON CITY
Mailing Address - State:NV
Mailing Address - Zip Code:89706-0425
Mailing Address - Country:US
Mailing Address - Phone:775-843-4254
Mailing Address - Fax:775-882-2961
Practice Address - Street 1:3332 SOMERSET WAY
Practice Address - Street 2:
Practice Address - City:CARSON CITY
Practice Address - State:NV
Practice Address - Zip Code:89705-7203
Practice Address - Country:US
Practice Address - Phone:775-843-4254
Practice Address - Fax:775-882-2961
Is Sole Proprietor?:No
Enumeration Date:2007-09-27
Last Update Date:2009-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV100511714Medicaid