Provider Demographics
NPI:1366727646
Name:KILLIAN COUNSELING & CONSULTING
Entity type:Organization
Organization Name:KILLIAN COUNSELING & CONSULTING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:VICKIE
Authorized Official - Middle Name:
Authorized Official - Last Name:KILLIAN
Authorized Official - Suffix:
Authorized Official - Credentials:LISW, LICDC
Authorized Official - Phone:937-361-4457
Mailing Address - Street 1:2600 FAR HILLS AVE
Mailing Address - Street 2:STE 304
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45419-1687
Mailing Address - Country:US
Mailing Address - Phone:937-361-4457
Mailing Address - Fax:
Practice Address - Street 1:2600 FAR HILLS AVE
Practice Address - Street 2:STE 304
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45419-1687
Practice Address - Country:US
Practice Address - Phone:937-361-4457
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-18
Last Update Date:2011-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH933459101YA0400X
OH0007910104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty