Individual
JORDAN DAVID LILL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
3401 45TH ST S, FARGO, ND 58104-8970
(701) 356-4384
Mailing address
3401 45TH ST S, FARGO, ND 58104-8970
(701) 356-4384
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
10727
NE
103K00000X
Behavior Analyst
116
MN
103K00000X
Behavior Analyst
Primary
72
ND
Other
Enumeration date
11/04/2015
Last updated
04/14/2025
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