Provider Demographics
NPI:1215686944
Name:ODETTE, JILL LEANN (LPC, NCC)
Entity type:Individual
Prefix:
First Name:JILL
Middle Name:LEANN
Last Name:ODETTE
Suffix:
Gender:F
Credentials:LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6101 COOK RD
Mailing Address - Street 2:
Mailing Address - City:SWARTZ CREEK
Mailing Address - State:MI
Mailing Address - Zip Code:48473-9164
Mailing Address - Country:US
Mailing Address - Phone:810-569-2591
Mailing Address - Fax:
Practice Address - Street 1:6101 COOK RD
Practice Address - Street 2:
Practice Address - City:SWARTZ CREEK
Practice Address - State:MI
Practice Address - Zip Code:48473-9164
Practice Address - Country:US
Practice Address - Phone:810-569-2591
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-21
Last Update Date:2022-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401011668101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional