Provider Demographics
NPI:1629950035
Name:ELLISON, JILLIAN COZETE (LMFT)
Entity type:Individual
Prefix:
First Name:JILLIAN
Middle Name:COZETE
Last Name:ELLISON
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 1:78150 CALLE TAMPICO STE 200I
Mailing Address - Street 2:
Mailing Address - City:LA QUINTA
Mailing Address - State:CA
Mailing Address - Zip Code:92253-7406
Mailing Address - Country:US
Mailing Address - Phone:760-836-6292
Mailing Address - Fax:
Practice Address - Street 1:78150 CALLE TAMPICO
Practice Address - Street 2:SUITE 200-I
Practice Address - City:LA QUINTA
Practice Address - State:CA
Practice Address - Zip Code:92253-7406
Practice Address - Country:US
Practice Address - Phone:760-836-6292
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-24
Last Update Date:2025-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA156597106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist