MEDICARE: MATTHEW 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	101YM0800X	Mental Health Counselor	74859	CA
2	101YP2500X	Professional Counselor	74859	CA
3	106H00000X	Marriage & Family Therapist	74859	CA

General Provider Information

NPI Number	:	1396142824
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MATTHEW KIRBY

Provider Business Mailing Address
First Line	:	1319 KANSAS CIR
Second Line	:
City	:	CONCORD
State	:	CA
Zip	:	94521-4614
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1319 KANSAS CIR
Second Line	:
City	:	CONCORD
State	:	CA
Zip	:	94521-4614
Country	:	US
Telephone Number	:	805-698-8297
Fax Number	:

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

Provider Enumeration Date	:	11/26/2014
Last Update Date	:	11/26/2014

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Directions to “ MATTHEW KIRBY ” Practice Location

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