Provider Demographics
NPI:1124833447
Name:KILGORE, AMANDA (MED, LPC)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:KILGORE
Suffix:
Gender:F
Credentials:MED, LPC
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:
Other - Last Name:WHITE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MED, LPC
Mailing Address - Street 1:1913 HUNTINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:NICHOLS HILLS
Mailing Address - State:OK
Mailing Address - Zip Code:73116-5525
Mailing Address - Country:US
Mailing Address - Phone:405-401-8629
Mailing Address - Fax:
Practice Address - Street 1:1913 HUNTINGTON AVE
Practice Address - Street 2:
Practice Address - City:NICHOLS HILLS
Practice Address - State:OK
Practice Address - Zip Code:73116-5525
Practice Address - Country:US
Practice Address - Phone:405-401-8629
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-12
Last Update Date:2025-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK11691101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health