Provider Demographics
NPI:1912033275
Name:SHANLEY, JILL F (LPC)
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:F
Last Name:SHANLEY
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:JILL
Other - Middle Name:
Other - Last Name:FINCY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LPC
Mailing Address - Street 1:900 E LAHARPE ST
Mailing Address - Street 2:
Mailing Address - City:KIRKSVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:63501-4520
Mailing Address - Country:US
Mailing Address - Phone:660-665-1962
Mailing Address - Fax:
Practice Address - Street 1:1448 AARON CT
Practice Address - Street 2:
Practice Address - City:JEFFERSON CITY
Practice Address - State:MO
Practice Address - Zip Code:65101-2863
Practice Address - Country:US
Practice Address - Phone:573-556-6589
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO002251101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional