Provider Demographics
NPI:1467752030
Name:KILCULLEN, KATHRYN ELIZABETH (LCDC)
Entity Type:Individual
Prefix:MS
First Name:KATHRYN
Middle Name:ELIZABETH
Last Name:KILCULLEN
Suffix:
Gender:F
Credentials:LCDC
Other - Prefix:MS
Other - First Name:KATIE
Other - Middle Name:
Other - Last Name:KILCULLEN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCDC
Mailing Address - Street 1:15400 KNOLL TRAIL DR
Mailing Address - Street 2:SUITE 109
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75248-3467
Mailing Address - Country:US
Mailing Address - Phone:214-738-2747
Mailing Address - Fax:972-392-9041
Practice Address - Street 1:15400 KNOLL TRAIL DR
Practice Address - Street 2:SUITE 109
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75248-3467
Practice Address - Country:US
Practice Address - Phone:214-738-2747
Practice Address - Fax:972-392-9041
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-28
Last Update Date:2010-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXLCDC 5614101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)