Provider Demographics
NPI:1124207790
Name:KILLIAN, BRIAN (LMHC/CAP)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:
Last Name:KILLIAN
Suffix:
Gender:M
Credentials:LMHC/CAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1501 BELCHER RD S
Mailing Address - Street 2:SUITE B-4
Mailing Address - City:LARGO
Mailing Address - State:FL
Mailing Address - Zip Code:33771-4505
Mailing Address - Country:US
Mailing Address - Phone:727-420-1146
Mailing Address - Fax:727-531-0950
Practice Address - Street 1:1501 BELCHER RD S
Practice Address - Street 2:SUITE B-4
Practice Address - City:LARGO
Practice Address - State:FL
Practice Address - Zip Code:33771-4505
Practice Address - Country:US
Practice Address - Phone:727-420-1146
Practice Address - Fax:727-531-0950
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-30
Last Update Date:2007-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCAP 1206101YA0400X
FLMH7746101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1206OtherCAP
FLMH7746OtherLMHC