Provider Demographics
NPI:1134693807
Name:KILIAN, BRACAL (LCPC)
Entity Type:Individual
Prefix:
First Name:BRACAL
Middle Name:
Last Name:KILIAN
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41 JOHNSON RD
Mailing Address - Street 2:
Mailing Address - City:NEW SWEDEN
Mailing Address - State:ME
Mailing Address - Zip Code:04762-3504
Mailing Address - Country:US
Mailing Address - Phone:907-957-6533
Mailing Address - Fax:
Practice Address - Street 1:128 SWEDEN ST STE 1
Practice Address - Street 2:
Practice Address - City:CARIBOU
Practice Address - State:ME
Practice Address - Zip Code:04736-2071
Practice Address - Country:US
Practice Address - Phone:207-999-1267
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-16
Last Update Date:2019-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECC5174101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MECC5174OtherMAINE LICENSING BOARD
AK129186OtherLPC