Provider Demographics
NPI:1376824557
Name:KILTY, AMANDA (MS, LPC, LCPC, NCC)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:KILTY
Suffix:
Gender:F
Credentials:MS, LPC, LCPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 663
Mailing Address - Street 2:
Mailing Address - City:GALLATIN GATEWAY
Mailing Address - State:MT
Mailing Address - Zip Code:59730-0663
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4 RABEL LN
Practice Address - Street 2:
Practice Address - City:GALLATIN GATEWAY
Practice Address - State:MT
Practice Address - Zip Code:59730-7000
Practice Address - Country:US
Practice Address - Phone:307-399-6276
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-01
Last Update Date:2023-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT21831101YP2500X
WY1372101YP2500X
171M00000X
WY598101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY598OtherSTATE LICENSE