Provider Demographics
NPI:1770701633
Name:LEWIS, JILL COLETTE (MA LAC, GUIDANCE)
Entity type:Individual
Prefix:MRS
First Name:JILL
Middle Name:COLETTE
Last Name:LEWIS
Suffix:
Gender:F
Credentials:MA LAC, GUIDANCE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 2500
Mailing Address - Street 2:
Mailing Address - City:SNOWFLAKE
Mailing Address - State:AZ
Mailing Address - Zip Code:85937
Mailing Address - Country:US
Mailing Address - Phone:928-243-1441
Mailing Address - Fax:
Practice Address - Street 1:8176 NORTH WESTOVER
Practice Address - Street 2:
Practice Address - City:JOSEPH CITY
Practice Address - State:AZ
Practice Address - Zip Code:86032
Practice Address - Country:US
Practice Address - Phone:928-288-3307
Practice Address - Fax:928-288-3309
Is Sole Proprietor?:No
Enumeration Date:2007-04-23
Last Update Date:2009-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLAC-11268101Y00000X
AZ2331144101YS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool