Provider Demographics
NPI:1972820223
Name:KILLHAM, KELLY LEIGH (LCSW)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:LEIGH
Last Name:KILLHAM
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:516 FULLER AVE STE 1
Mailing Address - Street 2:
Mailing Address - City:HELENA
Mailing Address - State:MT
Mailing Address - Zip Code:59601-3421
Mailing Address - Country:US
Mailing Address - Phone:406-431-9045
Mailing Address - Fax:
Practice Address - Street 1:500 S LAMBORN ST
Practice Address - Street 2:
Practice Address - City:HELENA
Practice Address - State:MT
Practice Address - Zip Code:59601-5417
Practice Address - Country:US
Practice Address - Phone:406-442-7920
Practice Address - Fax:406-442-7949
Is Sole Proprietor?:No
Enumeration Date:2010-04-27
Last Update Date:2022-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT9391041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical