MEDICARE: LUCILLE JANE KIRBY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101Y00000X	Counselor

General Provider Information

NPI Number	:	1043152713
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LUCILLE JANE KIRBY

Provider Business Mailing Address
First Line	:	192 SAFE HAVEN DR
Second Line	:
City	:	CLARKSBURG
State	:	WV
Zip	:	26301-9103
Country	:	US
Telephone Number	:	304-622-1907
Fax Number	:

Provider Business Practice Location Address
First Line	:	192 SAFE HAVEN DR
Second Line	:
City	:	CLARKSBURG
State	:	WV
Zip	:	26301-9103
Country	:	US
Telephone Number	:	304-622-1907
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/09/2026
Last Update Date	:	04/09/2026

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Directions to “ LUCILLE JANE KIRBY ” Practice Location

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