Provider Demographics
NPI:1821340704
Name:PHILLIPS, JILL (LPC)
Entity type:Individual
Prefix:
First Name:JILL
Middle Name:
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:JILL
Other - Middle Name:
Other - Last Name:PERRY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NCC, LPC
Mailing Address - Street 1:500 MARKET ST STE 200B
Mailing Address - Street 2:
Mailing Address - City:BEAVER
Mailing Address - State:PA
Mailing Address - Zip Code:15009-2998
Mailing Address - Country:US
Mailing Address - Phone:724-494-6750
Mailing Address - Fax:724-709-7273
Practice Address - Street 1:500 MARKET ST STE 200B
Practice Address - Street 2:
Practice Address - City:BEAVER
Practice Address - State:PA
Practice Address - Zip Code:15009-2998
Practice Address - Country:US
Practice Address - Phone:724-494-6750
Practice Address - Fax:724-709-7273
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-03
Last Update Date:2024-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC002431101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional