Healthcare Provider Details

I. General information

NPI: 1376824557
Provider Name (Legal Business Name): AMANDA KILTY MS, LPC, LCPC, NCC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/01/2011
Last Update Date: 11/01/2023
Certification Date: 11/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4 RABEL LN
GALLATIN GATEWAY MT
59730-7000
US

IV. Provider business mailing address

PO BOX 663
GALLATIN GATEWAY MT
59730-0663
US

V. Phone/Fax

Practice location:
  • Phone: 307-399-6276
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number598
License Number StateWY
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number21831
License Number StateMT
# 3
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number1372
License Number StateWY
# 4
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: