Provider Demographics
NPI:1447329420
Name:KIRK, KRISTI MICHELLE (LPC)
Entity type:Individual
Prefix:
First Name:KRISTI
Middle Name:MICHELLE
Last Name:KIRK
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 OLD HEWITT RD STE C
Mailing Address - Street 2:
Mailing Address - City:WACO
Mailing Address - State:TX
Mailing Address - Zip Code:76712-3548
Mailing Address - Country:US
Mailing Address - Phone:254-752-1183
Mailing Address - Fax:254-756-5092
Practice Address - Street 1:201 OLD HEWITT RD STE C
Practice Address - Street 2:
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76712-3548
Practice Address - Country:US
Practice Address - Phone:254-752-1183
Practice Address - Fax:254-756-5092
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-06
Last Update Date:2018-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX17187101YP2500X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX168924201Medicaid