Provider Demographics
NPI:1720844228
Name:KILLION, JEFFREY (LPC-MHSP (TEMP))
Entity Type:Individual
Prefix:MR
First Name:JEFFREY
Middle Name:
Last Name:KILLION
Suffix:
Gender:M
Credentials:LPC-MHSP (TEMP)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5500 POPLAR AVE STE 11
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38119-3718
Mailing Address - Country:US
Mailing Address - Phone:901-321-0980
Mailing Address - Fax:
Practice Address - Street 1:5500 POPLAR AVE STE 11
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38119-3718
Practice Address - Country:US
Practice Address - Phone:901-321-0980
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-22
Last Update Date:2024-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN6901103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling