Provider Demographics
NPI:1043019888
Name:DULEY, JILLIAN (CCHT, CHT,)
Entity type:Individual
Prefix:
First Name:JILLIAN
Middle Name:
Last Name:DULEY
Suffix:
Gender:
Credentials:CCHT, CHT,
Other - Prefix:
Other - First Name:JILLIAN
Other - Middle Name:
Other - Last Name:HOLPER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CCHT, CHT
Mailing Address - Street 1:2435 E SOUTHERN AVE STE 5
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85282-7628
Mailing Address - Country:US
Mailing Address - Phone:928-793-3990
Mailing Address - Fax:
Practice Address - Street 1:2435 E SOUTHERN AVE STE 5
Practice Address - Street 2:
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85282-7628
Practice Address - Country:US
Practice Address - Phone:928-793-3990
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-12
Last Update Date:2025-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ619-152101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health