Basic Information
| Provider Information | |||||||||
| NPI: | 1194824623 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BILLS | ||||||||
| FirstName: | JODI | ||||||||
| MiddleName: | L | ||||||||
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| Credential: | LPC, QMHP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2909 BENT AVE | ||||||||
| Address2: | |||||||||
| City: | CHEYENNE | ||||||||
| State: | WY | ||||||||
| PostalCode: | 820012742 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3077609446 | ||||||||
| FaxNumber: | 3072222925 | ||||||||
| Practice Location | |||||||||
| Address1: | 1700 E BARNETT RD | ||||||||
| Address2: | |||||||||
| City: | MEDFORD | ||||||||
| State: | OR | ||||||||
| PostalCode: | 975040052 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5414762373 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/21/2006 | ||||||||
| LastUpdateDate: | 04/23/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101Y00000X | C5271 | OR | N | Behavioral Health & Social Service Providers | Counselor | 101YA0400X | 337 | WY | N | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) | 101YP2500X | 1284 | WY | Y | Behavioral Health & Social Service Providers | Counselor | Professional |
ID Information
| ID | Type | State | Issuer | Description | 313542 | 01 | WY | BLUE CROSS BLUE SHIELD | OTHER |