Healthcare Provider Details

I. General information

NPI: 1851885735
Provider Name (Legal Business Name): GEORGE KILLIAN LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2018
Last Update Date: 06/14/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 N WASHINGTON ST STE 229
FARMINGTON MO
63640-1716
US

IV. Provider business mailing address

400 N WASHINGTON ST STE 229
FARMINGTON MO
63640-1716
US

V. Phone/Fax

Practice location:
  • Phone: 573-218-9653
  • Fax: 573-803-1405
Mailing address:
  • Phone: 573-218-9653
  • Fax: 573-803-1405

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: