Provider Demographics
NPI:1770064800
Name:PEELER, JILL NICOLE
Entity type:Individual
Prefix:
First Name:JILL
Middle Name:NICOLE
Last Name:PEELER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1683 NOVATO BLVD STE 1B
Mailing Address - Street 2:
Mailing Address - City:NOVATO
Mailing Address - State:CA
Mailing Address - Zip Code:94947-3204
Mailing Address - Country:US
Mailing Address - Phone:510-630-0831
Mailing Address - Fax:707-759-3810
Practice Address - Street 1:1683 NOVATO BLVD STE 1B
Practice Address - Street 2:
Practice Address - City:NOVATO
Practice Address - State:CA
Practice Address - Zip Code:94947-3204
Practice Address - Country:US
Practice Address - Phone:510-630-0831
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-27
Last Update Date:2022-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA134837106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist