Provider Demographics
NPI:1457597528
Name:CHILTON, KATHLEEN A (LMFT)
Entity Type:Individual
Prefix:MS
First Name:KATHLEEN
Middle Name:A
Last Name:CHILTON
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:261 E 16TH AVE
Mailing Address - Street 2:SUITE, 3
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97401-4105
Mailing Address - Country:US
Mailing Address - Phone:541-343-3772
Mailing Address - Fax:
Practice Address - Street 1:261 E 16TH AVE
Practice Address - Street 2:SUITE, 3
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-4105
Practice Address - Country:US
Practice Address - Phone:541-343-3772
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-19
Last Update Date:2014-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORR0696106H00000X
ORT0737106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist