Provider Demographics
NPI:1235913971
Name:KILLORAN, MOIRA (PLPC)
Entity Type:Individual
Prefix:
First Name:MOIRA
Middle Name:
Last Name:KILLORAN
Suffix:
Gender:F
Credentials:PLPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1827 RUTGER ST
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63104-2943
Mailing Address - Country:US
Mailing Address - Phone:608-317-4087
Mailing Address - Fax:
Practice Address - Street 1:3 THE PINES CT STE B
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63141-6081
Practice Address - Country:US
Practice Address - Phone:608-317-4087
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-23
Last Update Date:2023-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2022009293101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health