Provider Demographics
NPI:1750129128
Name:GILLETTE, JOLANA JAYNE (BHT)
Entity type:Individual
Prefix:
First Name:JOLANA
Middle Name:JAYNE
Last Name:GILLETTE
Suffix:
Gender:F
Credentials:BHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1434 N JUNIPER DR
Mailing Address - Street 2:
Mailing Address - City:CASA GRANDE
Mailing Address - State:AZ
Mailing Address - Zip Code:85122-2813
Mailing Address - Country:US
Mailing Address - Phone:520-509-5166
Mailing Address - Fax:
Practice Address - Street 1:6625 E MAIN ST
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85205-9038
Practice Address - Country:US
Practice Address - Phone:602-500-9717
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-18
Last Update Date:2024-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician