Provider Demographics
NPI:1528505120
Name:GATZ, JILLIAN (LMFT)
Entity type:Individual
Prefix:MRS
First Name:JILLIAN
Middle Name:
Last Name:GATZ
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4296 SASHA TRL
Mailing Address - Street 2:
Mailing Address - City:SAINT CLOUD
Mailing Address - State:FL
Mailing Address - Zip Code:34772-8869
Mailing Address - Country:US
Mailing Address - Phone:321-223-7070
Mailing Address - Fax:
Practice Address - Street 1:4101 NEPTUNE RD STE A
Practice Address - Street 2:
Practice Address - City:SAINT CLOUD
Practice Address - State:FL
Practice Address - Zip Code:34769-6754
Practice Address - Country:US
Practice Address - Phone:321-223-7070
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-21
Last Update Date:2022-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMT3287106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist