Provider Demographics
NPI:1245971175
Name:KILGORE, HEATHER MARIE (LMFT, IMFT)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:MARIE
Last Name:KILGORE
Suffix:
Gender:F
Credentials:LMFT, IMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 143
Mailing Address - Street 2:
Mailing Address - City:SAMOA
Mailing Address - State:CA
Mailing Address - Zip Code:95564-0143
Mailing Address - Country:US
Mailing Address - Phone:707-340-7434
Mailing Address - Fax:
Practice Address - Street 1:123 SUNSET AVE
Practice Address - Street 2:
Practice Address - City:SAMOA
Practice Address - State:CA
Practice Address - Zip Code:95564-9544
Practice Address - Country:US
Practice Address - Phone:707-340-7434
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-05
Last Update Date:2025-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA154353106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist