Provider Demographics
NPI:1285935544
Name:SAMONTE, JILL VENAY (LCPC)
Entity type:Individual
Prefix:
First Name:JILL
Middle Name:VENAY
Last Name:SAMONTE
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 E 5TH AVE
Mailing Address - Street 2:PRAIRIE FAMILY THERAPY
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60563-3177
Mailing Address - Country:US
Mailing Address - Phone:630-579-8070
Mailing Address - Fax:
Practice Address - Street 1:300 E 5TH AVE
Practice Address - Street 2:PRAIRIE FAMILY THERAPY
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60563-3177
Practice Address - Country:US
Practice Address - Phone:630-579-8070
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-03
Last Update Date:2010-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180-002913101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional