Provider Demographics
NPI:1053534537
Name:MCCLELLAN, JILL MILLER (LPCC, LICDC,LSW, NCC)
Entity type:Individual
Prefix:MRS
First Name:JILL
Middle Name:MILLER
Last Name:MCCLELLAN
Suffix:
Gender:F
Credentials:LPCC, LICDC,LSW, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:454 BALDWIN DR
Mailing Address - Street 2:
Mailing Address - City:HOWARD
Mailing Address - State:OH
Mailing Address - Zip Code:43028-8043
Mailing Address - Country:US
Mailing Address - Phone:740-392-5668
Mailing Address - Fax:
Practice Address - Street 1:17 ALDRICH RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43214-2640
Practice Address - Country:US
Practice Address - Phone:614-203-4593
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH913133101YA0400X
OH16099101YM0800X
OHE2147101YP2500X
OHS6906104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Not Answered104100000XBehavioral Health & Social Service ProvidersSocial Worker