Provider Demographics
NPI:1952808073
Name:JILLIAN WINTERS
Entity Type:Organization
Organization Name:JILLIAN WINTERS
Other - Org Name:JILLIAN WINTERS, MA, LCPC, NCC
Other - Org Type:Other Name
Authorized Official - Title/Position:PROFESSIONAL COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:JILLIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:WINTERS
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LCPC, NCC
Authorized Official - Phone:208-971-1220
Mailing Address - Street 1:1524 W HAYS ST STE 201
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83702-4035
Mailing Address - Country:US
Mailing Address - Phone:208-971-1220
Mailing Address - Fax:
Practice Address - Street 1:1524 W HAYS ST STE 201
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83702-4035
Practice Address - Country:US
Practice Address - Phone:208-971-1220
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-06
Last Update Date:2018-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID6605261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)