Provider Demographics
NPI:1770185803
Name:KILLIAN, EMMA BACHMAN (MD, LMHC #21134)
Entity Type:Individual
Prefix:
First Name:EMMA
Middle Name:BACHMAN
Last Name:KILLIAN
Suffix:
Gender:F
Credentials:MD, LMHC #21134
Other - Prefix:
Other - First Name:EMMA
Other - Middle Name:BACHMAN
Other - Last Name:KILLIAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD, LMHC #21134
Mailing Address - Street 1:903 STETSON ST
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32804-5768
Mailing Address - Country:US
Mailing Address - Phone:407-579-0091
Mailing Address - Fax:
Practice Address - Street 1:668 N ORLANDO AVE STE 210
Practice Address - Street 2:
Practice Address - City:MAITLAND
Practice Address - State:FL
Practice Address - Zip Code:32751-4459
Practice Address - Country:US
Practice Address - Phone:407-453-0555
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-13
Last Update Date:2022-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL19722101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health