Provider Demographics
NPI:1720298177
Name:KILLOUGH, MOLLIE DEBORAH (LPC, LMFT)
Entity Type:Individual
Prefix:
First Name:MOLLIE
Middle Name:DEBORAH
Last Name:KILLOUGH
Suffix:
Gender:F
Credentials:LPC, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12830 HILLCREST RD
Mailing Address - Street 2:SUITE 221
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75230-1527
Mailing Address - Country:US
Mailing Address - Phone:972-490-7507
Mailing Address - Fax:972-239-3596
Practice Address - Street 1:12830 HILLCREST RD
Practice Address - Street 2:SUITE 221
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75230-1527
Practice Address - Country:US
Practice Address - Phone:972-490-7507
Practice Address - Fax:972-239-3596
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX9771101YM0800X
TX003940041691106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX9771OtherLPC
TX003940041691OtherLMFT