Provider Demographics
NPI:1730236704
Name:THORNGREN, JILL M (PHD, LCPC)
Entity type:Individual
Prefix:DR
First Name:JILL
Middle Name:M
Last Name:THORNGREN
Suffix:
Gender:F
Credentials:PHD, LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:815 WIERDA WAY
Mailing Address - Street 2:
Mailing Address - City:MANHATTAN
Mailing Address - State:MT
Mailing Address - Zip Code:59741-8675
Mailing Address - Country:US
Mailing Address - Phone:605-651-9433
Mailing Address - Fax:
Practice Address - Street 1:985 TECHNOLOGY BLVD STE 101
Practice Address - Street 2:
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59718-4015
Practice Address - Country:US
Practice Address - Phone:605-651-9433
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-04
Last Update Date:2024-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
MT893101YM0800X
MTLCPC 893101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health