Provider Demographics
NPI:1275768038
Name:KILGORE, KEILA K (MA, NCC, LPC)
Entity Type:Individual
Prefix:
First Name:KEILA
Middle Name:K
Last Name:KILGORE
Suffix:
Gender:F
Credentials:MA, NCC, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 N HOWELL ST
Mailing Address - Street 2:SUITE 260
Mailing Address - City:HILLSDALE
Mailing Address - State:MI
Mailing Address - Zip Code:49242-1780
Mailing Address - Country:US
Mailing Address - Phone:517-315-1367
Mailing Address - Fax:517-563-2673
Practice Address - Street 1:4 N HOWELL ST
Practice Address - Street 2:SUITE 260
Practice Address - City:HILLSDALE
Practice Address - State:MI
Practice Address - Zip Code:49242-1780
Practice Address - Country:US
Practice Address - Phone:517-315-1367
Practice Address - Fax:517-563-2673
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-22
Last Update Date:2009-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401009781101Y00000X, 101YM0800X, 101YP2500X
MICC-XVW450025540101YS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool