Provider Demographics
NPI:1306493325
Name:MACON, JILL S (LPC, LCPC)
Entity type:Individual
Prefix:
First Name:JILL
Middle Name:S
Last Name:MACON
Suffix:
Gender:F
Credentials:LPC, LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:556 S BELMONT ST
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67218-2202
Mailing Address - Country:US
Mailing Address - Phone:405-590-2974
Mailing Address - Fax:888-964-2524
Practice Address - Street 1:556 S BELMONT ST
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67218-2202
Practice Address - Country:US
Practice Address - Phone:405-590-2974
Practice Address - Fax:888-964-2524
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-23
Last Update Date:2024-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK11278101YP2500X
KS03528101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional