Provider Demographics
NPI:1508203480
Name:HUNTINGTON, KILEY (LCSW)
Entity Type:Individual
Prefix:
First Name:KILEY
Middle Name:
Last Name:HUNTINGTON
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11721 PEGASUS RD
Mailing Address - Street 2:
Mailing Address - City:BELLEMONT
Mailing Address - State:AZ
Mailing Address - Zip Code:86015-1018
Mailing Address - Country:US
Mailing Address - Phone:435-632-5823
Mailing Address - Fax:
Practice Address - Street 1:11721 PEGASUS RD
Practice Address - Street 2:
Practice Address - City:BELLEMONT
Practice Address - State:AZ
Practice Address - Zip Code:86015-1018
Practice Address - Country:US
Practice Address - Phone:435-632-5823
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-31
Last Update Date:2023-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLCSW-216631041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical