Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TA0400X | Addiction Psychologist (Substance Use Disorder) | 3781 | AZ |
N | 103TB0200X | Cognitive & Behavioral Psychologist | 3781 | AZ |
N | 103G00000X | Clinical Psychologist | 3781 | AZ |
N | 103TC0700X | Clinical Psychologist | 3781 | AZ |
N | 103TC1900X | Counseling Psychologist | 3781 | AZ |
NPI | 1447294947 |
---|---|
Provider Name | Dr. Heath Kilgore |
First Address | Phoenix, AZ 85012-2331 |
Second Address | Phoenix, AZ 85007-5902 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/06/2006 |
Last Update Date | 14/04/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
100234 | (05) | AZ |