Basic Information
| Provider Information | |||||||||
| NPI: | 1629468814 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ANDERSON | ||||||||
| FirstName: | JILLIAN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3500 LAKESIDE CT STE 101 | ||||||||
| Address2: | |||||||||
| City: | RENO | ||||||||
| State: | NV | ||||||||
| PostalCode: | 895094862 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7757866880 | ||||||||
| FaxNumber: | 7757866899 | ||||||||
| Practice Location | |||||||||
| Address1: | 3500 LAKESIDE CT STE 101 | ||||||||
| Address2: | |||||||||
| City: | RENO | ||||||||
| State: | NV | ||||||||
| PostalCode: | 895094862 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7757866880 | ||||||||
| FaxNumber: | 7757866899 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/27/2015 | ||||||||
| LastUpdateDate: | 09/22/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/22/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | N | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) | 101YA0400X | 1843-L | NV | N | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) | 106H00000X | 2730 | NV | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.