Provider Demographics
NPI:1548325665
Name:GRASSMAN, JILL ELIZABETH (LPC, BCIAC)
Entity type:Individual
Prefix:MS
First Name:JILL
Middle Name:ELIZABETH
Last Name:GRASSMAN
Suffix:
Gender:F
Credentials:LPC, BCIAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 210095
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85721-0095
Mailing Address - Country:US
Mailing Address - Phone:520-621-3334
Mailing Address - Fax:520-626-6105
Practice Address - Street 1:1224 E LOWELL AVE
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85721-0095
Practice Address - Country:US
Practice Address - Phone:520-621-3334
Practice Address - Fax:520-626-6105
Is Sole Proprietor?:No
Enumeration Date:2006-12-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPC 2333101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional