Provider Demographics
NPI:1053464933
Name:KILLIAN, KEVIN LEE (LMHP)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:LEE
Last Name:KILLIAN
Suffix:
Gender:M
Credentials:LMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:319 SOUTH 17TH STREET #240
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68102
Mailing Address - Country:US
Mailing Address - Phone:402-558-3856
Mailing Address - Fax:402-558-3039
Practice Address - Street 1:673 SAN JOSE AVE
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94110-4914
Practice Address - Country:US
Practice Address - Phone:415-282-3789
Practice Address - Fax:415-695-0829
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-22
Last Update Date:2016-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE3112101YM0800X
101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health