Provider Demographics
NPI:1447915533
Name:KILLORAN, KRISTIN (LPCI)
Entity type:Individual
Prefix:
First Name:KRISTIN
Middle Name:
Last Name:KILLORAN
Suffix:
Gender:F
Credentials:LPCI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1683 NE SHEPARD RD
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97701-4164
Mailing Address - Country:US
Mailing Address - Phone:541-797-9131
Mailing Address - Fax:
Practice Address - Street 1:19820 VILLAGE OFFICE CT STE 301
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97702-2950
Practice Address - Country:US
Practice Address - Phone:541-797-9131
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-03
Last Update Date:2021-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORR7198101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health