1972759512 NPI number — MS. KELLY C KIRBY MS, LPCC

Table of content: MS. KELLY C KIRBY MS, LPCC (NPI 1972759512)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1972759512 NPI number — MS. KELLY C KIRBY MS, LPCC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KIRBY
Provider First Name:
KELLY
Provider Middle Name:
C
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
MS, LPCC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1972759512
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/30/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
577 HUFF ST
Provider Second Line Business Mailing Address:
SUITE 1B
Provider Business Mailing Address City Name:
WINONA
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55987-3330
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
507-358-4380
Provider Business Mailing Address Fax Number:
320-323-4616

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
577 HUFF ST
Provider Second Line Business Practice Location Address:
SUITE 1B
Provider Business Practice Location Address City Name:
WINONA
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55987-3330
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
507-358-4380
Provider Business Practice Location Address Fax Number:
320-323-4616
Provider Enumeration Date:
08/14/2008

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101Y00000X , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YM0800X , with the licence number: CC00277 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 150913 . This is a "UCARE" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 256057700 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3H671EI . This is a "BLUE CROSS/BLUE SHIELD" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 6212367 . This is a "UBH" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".




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