Healthcare Provider Details

I. General information

NPI: 1790462893
Provider Name (Legal Business Name): WILLIAM SKYLER KIRK LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2023
Last Update Date: 08/28/2026
Certification Date: 08/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

836 5TH AVE # 249
BELLE FOURCHE SD
57717-1607
US

IV. Provider business mailing address

836 5TH AVE # 249
BELLE FOURCHE SD
57717-1607
US

V. Phone/Fax

Practice location:
  • Phone: 970-703-3260
  • Fax:
Mailing address:
  • Phone: 970-703-3260
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number254132
License Number StateAK
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberTPSW6901
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberCSW.09932683
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: