1497464929 NPI number — MRS. JILL KIMBERLY OFOH LPC, MED

Table of content: MRS. JILL KIMBERLY OFOH LPC, MED (NPI 1497464929)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1497464929 NPI number — MRS. JILL KIMBERLY OFOH LPC, MED

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
OFOH
Provider First Name:
JILL
Provider Middle Name:
KIMBERLY
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
LPC, MED
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
WILKINS
Provider Other First Name:
JILL
Provider Other Middle Name:
KIMBERLY
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
LPC
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1497464929
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/23/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2609 TUSCARORA TRL
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GLENN HEIGHTS
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75154-8956
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
325-234-5472
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2609 TUSCARORA TRL
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GLENN HEIGHTS
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75154-8956
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
325-234-5472
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/23/2022

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YP2500X , with the licence number:  73989 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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