Healthcare Provider Details

I. General information

NPI: 1568031631
Provider Name (Legal Business Name): ANNA MAY KILGRO LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2021
Last Update Date: 01/28/2025
Certification Date: 01/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5701 CARMEL AVE NE STE B
ALBUQUERQUE NM
87113-2843
US

IV. Provider business mailing address

5701 CARMEL AVE NE STE B
ALBUQUERQUE NM
87113-2843
US

V. Phone/Fax

Practice location:
  • Phone: 505-308-5226
  • Fax: 505-514-0754
Mailing address:
  • Phone: 505-308-5226
  • Fax: 505-514-0754

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberCTB-2024-0349
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: