Provider Demographics
NPI:1073334371
Name:ROY, JILLIAN PAULE (C-LCPC)
Entity type:Individual
Prefix:
First Name:JILLIAN
Middle Name:PAULE
Last Name:ROY
Suffix:
Gender:F
Credentials:C-LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 LEAVITT ST
Mailing Address - Street 2:
Mailing Address - City:SKOWHEGAN
Mailing Address - State:ME
Mailing Address - Zip Code:04976-1843
Mailing Address - Country:US
Mailing Address - Phone:888-922-4736
Mailing Address - Fax:844-331-2315
Practice Address - Street 1:30 LEAVITT ST
Practice Address - Street 2:
Practice Address - City:SKOWHEGAN
Practice Address - State:ME
Practice Address - Zip Code:04976-1843
Practice Address - Country:US
Practice Address - Phone:888-922-4736
Practice Address - Fax:844-331-2315
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-18
Last Update Date:2024-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEXL7745101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health