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NPI Code Detail

MEDICARE: WENDY KAY KILLAM LPC

MEDICARE: WENDY KAY KILLAM LPC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YM0800XMental Health Counselor13849TX

General Provider Information

NPI Number : 1194592964
Entity Type Code : Individual
Provider Name (Legal Business Name) : WENDY KAY KILLAM LPC
Provider Business Mailing Address
First Line : 146 LEWELLIN PL
Second Line :
City : LUFKIN
State : TX
Zip : 75904-6976
Country : US
Telephone Number : 936-615-8603
Fax Number :
Provider Business Practice Location Address
First Line : 320 NORTH ST STE 206
Second Line :
City : NACOGDOCHES
State : TX
Zip : 75961-5018
Country : US
Telephone Number : 936-244-5681
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/11/2023
Last Update Date : 12/11/2023

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Directions to “ WENDY KAY KILLAM LPC” Practice Location

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