Provider Demographics
NPI:1003959362
Name:SHEETZ, JILL MARIE
Entity type:Individual
Prefix:MS
First Name:JILL
Middle Name:MARIE
Last Name:SHEETZ
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:JILL
Other - Middle Name:M
Other - Last Name:SHEETZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MFTI
Mailing Address - Street 1:2130 STOCKTON BLVD
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95817-1337
Mailing Address - Country:US
Mailing Address - Phone:916-875-0701
Mailing Address - Fax:
Practice Address - Street 1:2130 STOCKTON BLVD
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95817-1337
Practice Address - Country:US
Practice Address - Phone:916-875-0701
Practice Address - Fax:916-876-5615
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-15
Last Update Date:2015-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA58106101YM0800X
101YM0800X
CA86823106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health