Provider Demographics
NPI:1447719075
Name:KILLGORE, DEANNA CAROL (MA, LPC)
Entity type:Individual
Prefix:
First Name:DEANNA
Middle Name:CAROL
Last Name:KILLGORE
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:DEANNA
Other - Middle Name:CAROL
Other - Last Name:PATTISON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5265 N ACADEMY BLVD STE 2600
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80918-4081
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5265 N ACADEMY BLVD STE 2600
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80918-4081
Practice Address - Country:US
Practice Address - Phone:719-243-1970
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-13
Last Update Date:2024-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COLPC.0020927101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional