Provider Demographics
NPI:1750757621
Name:HAMM, KILIE S (LPC- CANDIDATE)
Entity type:Individual
Prefix:MS
First Name:KILIE
Middle Name:S
Last Name:HAMM
Suffix:
Gender:F
Credentials:LPC- CANDIDATE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18542 EW 15 RD
Mailing Address - Street 2:
Mailing Address - City:DELAWARE
Mailing Address - State:OK
Mailing Address - Zip Code:74027-1173
Mailing Address - Country:US
Mailing Address - Phone:918-534-6712
Mailing Address - Fax:
Practice Address - Street 1:12834 S OLD US 169
Practice Address - Street 2:
Practice Address - City:OOLOGAH
Practice Address - State:OH
Practice Address - Zip Code:74053
Practice Address - Country:US
Practice Address - Phone:918-695-2059
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-14
Last Update Date:2022-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No171M00000XOther Service ProvidersCase Manager/Care Coordinator