Provider Demographics
NPI:1194808196
Name:SHELDON, JILL AMY (MFTI)
Entity type:Individual
Prefix:
First Name:JILL
Middle Name:AMY
Last Name:SHELDON
Suffix:
Gender:F
Credentials:MFTI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4245 CLEMENT ST
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94121-1440
Mailing Address - Country:US
Mailing Address - Phone:415-752-9181
Mailing Address - Fax:
Practice Address - Street 1:555 NORTHGATE DR
Practice Address - Street 2:FAMILY SERVICE AGENCY OF MARIN
Practice Address - City:SAN RAFAEL
Practice Address - State:CA
Practice Address - Zip Code:94903-3680
Practice Address - Country:US
Practice Address - Phone:415-491-5700
Practice Address - Fax:415-491-5750
Is Sole Proprietor?:No
Enumeration Date:2006-10-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAIMF 46302101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health