Provider Demographics
NPI:1760982177
Name:GILLILAND, JESSICA CROFT (LMFT)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:CROFT
Last Name:GILLILAND
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2261 N SUNSET DR
Mailing Address - Street 2:
Mailing Address - City:LEHI
Mailing Address - State:UT
Mailing Address - Zip Code:84043-2822
Mailing Address - Country:US
Mailing Address - Phone:801-518-7603
Mailing Address - Fax:
Practice Address - Street 1:195 W MAIN ST # 106
Practice Address - Street 2:
Practice Address - City:LEHI
Practice Address - State:UT
Practice Address - Zip Code:84043-2145
Practice Address - Country:US
Practice Address - Phone:801-872-8229
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-13
Last Update Date:2024-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT10658579-3902106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist