Provider Demographics
NPI:1538593108
Name:HOGAN, JILL ANN (MFT)
Entity type:Individual
Prefix:MS
First Name:JILL
Middle Name:ANN
Last Name:HOGAN
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:MS
Other - First Name:JILL
Other - Middle Name:A
Other - Last Name:ELKINS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MFT
Mailing Address - Street 1:10 GLORIETA W
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92620-1850
Mailing Address - Country:US
Mailing Address - Phone:714-559-5692
Mailing Address - Fax:714-731-0154
Practice Address - Street 1:1151 DORE STREET
Practice Address - Street 2:STE 245
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660
Practice Address - Country:US
Practice Address - Phone:714-559-5692
Practice Address - Fax:714-731-0514
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-30
Last Update Date:2013-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC53633106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist