Provider Demographics
NPI:1720239650
Name:KILLOUGH, ELIZABETH J (LLPC)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:J
Last Name:KILLOUGH
Suffix:
Gender:F
Credentials:LLPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4211 KARLA CT
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48642-9241
Mailing Address - Country:US
Mailing Address - Phone:989-631-2419
Mailing Address - Fax:
Practice Address - Street 1:515 ADAMS ST
Practice Address - Street 2:
Practice Address - City:BAY CITY
Practice Address - State:MI
Practice Address - Zip Code:48708-5830
Practice Address - Country:US
Practice Address - Phone:989-894-2991
Practice Address - Fax:989-895-7669
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-09
Last Update Date:2008-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401008526101YA0400X, 251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No251S00000XAgenciesCommunity/Behavioral Health