Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP2500X | Professional Counselor | 15776 | TX |
NPI | 1003283946 |
---|---|
Provider Name | Mrs. Jill Marie Kirkley |
First Address | Tyler, TX 75703-1629 |
Second Address | Tyler, TX 75703-1629 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/08/2015 |
Last Update Date | 26/08/2015 |