Provider Demographics
NPI:1093870446
Name:KILGORE, MARTHA LYNNE (LPC)
Entity Type:Individual
Prefix:MS
First Name:MARTHA
Middle Name:LYNNE
Last Name:KILGORE
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:425 5TH AVE NW
Mailing Address - Street 2:
Mailing Address - City:ATTALLA
Mailing Address - State:AL
Mailing Address - Zip Code:35954-2214
Mailing Address - Country:US
Mailing Address - Phone:256-492-7800
Mailing Address - Fax:256-494-5536
Practice Address - Street 1:301 14TH ST NW
Practice Address - Street 2:
Practice Address - City:FT. PAYNE
Practice Address - State:AL
Practice Address - Zip Code:35967-3155
Practice Address - Country:US
Practice Address - Phone:256-845-4571
Practice Address - Fax:256-845-4582
Is Sole Proprietor?:No
Enumeration Date:2006-12-26
Last Update Date:2011-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL2005101YP2500X
AL2005AL101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional