Provider Demographics
NPI:1356987960
Name:ATHERTON, JILLIAN MARIE (EDD, LPCC-S)
Entity type:Individual
Prefix:DR
First Name:JILLIAN
Middle Name:MARIE
Last Name:ATHERTON
Suffix:
Gender:F
Credentials:EDD, LPCC-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8000 5 MILE RD STE 105
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45230-2187
Mailing Address - Country:US
Mailing Address - Phone:513-624-4500
Mailing Address - Fax:
Practice Address - Street 1:8000 5 MILE RD STE 105
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45230-2187
Practice Address - Country:US
Practice Address - Phone:513-624-4500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-19
Last Update Date:2020-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY103423101YP2500X
OHE2001897101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY103423OtherKENTUCKY BOARD OF LICENSED PROFESSIONAL COUNSELORS