Provider Demographics
NPI:1255219069
Name:SCHIRILLO-ELLIOTT, JEREMIAH (CBT)
Entity type:Individual
Prefix:
First Name:JEREMIAH
Middle Name:
Last Name:SCHIRILLO-ELLIOTT
Suffix:
Gender:M
Credentials:CBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9601 339TH ST S
Mailing Address - Street 2:
Mailing Address - City:ROY
Mailing Address - State:WA
Mailing Address - Zip Code:98580-9480
Mailing Address - Country:US
Mailing Address - Phone:360-628-0993
Mailing Address - Fax:253-215-4109
Practice Address - Street 1:9601 339TH ST S
Practice Address - Street 2:
Practice Address - City:ROY
Practice Address - State:WA
Practice Address - Zip Code:98580-9480
Practice Address - Country:US
Practice Address - Phone:360-628-0993
Practice Address - Fax:253-215-4109
Is Sole Proprietor?:No
Enumeration Date:2025-08-21
Last Update Date:2025-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACB70026260106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician