Provider Demographics
NPI:1326750266
Name:KILBOURNE, CARLI (LAC)
Entity Type:Individual
Prefix:
First Name:CARLI
Middle Name:
Last Name:KILBOURNE
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3113 E DANBURY RD UNIT 1
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85032-2042
Mailing Address - Country:US
Mailing Address - Phone:602-980-9999
Mailing Address - Fax:
Practice Address - Street 1:2060 W WHISPERING WIND DR STE 270
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85085-2869
Practice Address - Country:US
Practice Address - Phone:480-653-8434
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-22
Last Update Date:2022-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLAC-18762101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor