Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YM0800X | Mental Health Counselor | LPC-14036 | AZ |
NPI | 1003250275 |
---|---|
Provider Name | Mrs. Jill Ellis Mcmahon |
First Address | Scottsdale, AZ 85260-6991 |
Second Address | Scottsdale, AZ 85260-6991 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/04/2013 |
Last Update Date | 18/04/2013 |