Provider Demographics
NPI:1124669023
Name:ELLIOTT, JILL MARIE (MED COUNSELING)
Entity type:Individual
Prefix:
First Name:JILL
Middle Name:MARIE
Last Name:ELLIOTT
Suffix:
Gender:F
Credentials:MED COUNSELING
Other - Prefix:
Other - First Name:JILL
Other - Middle Name:MARIE
Other - Last Name:ELLIOTT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:JILL MARIE ROBERTSON
Mailing Address - Street 1:370 HALELOA PL APT H
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96821-2273
Mailing Address - Country:US
Mailing Address - Phone:907-843-1009
Mailing Address - Fax:
Practice Address - Street 1:370 HALELOA PL APT H
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96821-2273
Practice Address - Country:US
Practice Address - Phone:907-843-1009
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-01
Last Update Date:2019-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health