Healthcare Provider Details

I. General information

NPI: 1801102629
Provider Name (Legal Business Name): RENE KILLIAN LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: RENE HOLDMAN LCSW

II. Dates (important events)

Enumeration Date: 08/31/2010
Last Update Date: 08/03/2023
Certification Date: 08/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1085 MAPLE ST
FARMINGTON MO
63640-1955
US

IV. Provider business mailing address

1800 COMMUNITY
CLINTON MO
64735-8804
US

V. Phone/Fax

Practice location:
  • Phone: 573-756-5353
  • Fax: 573-756-4316
Mailing address:
  • Phone: 844-853-8937
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number2016014717
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: