Healthcare Provider Details

I. General information

NPI: 1598678674
Provider Name (Legal Business Name): AMY S KILGORE LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/28/2026
Last Update Date: 09/28/2026
Certification Date: 09/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23072 BROOKFOREST
NOVI MI
48375-4421
US

IV. Provider business mailing address

23072 BROOKFOREST
NOVI MI
48375-4421
US

V. Phone/Fax

Practice location:
  • Phone: 734-646-0259
  • Fax:
Mailing address:
  • Phone: 734-646-0259
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number6401009298
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: